CT-guided biopsy of breast lesions: When should it be considered?

Mammography, ultrasound, and magnetic resonance imaging (MRI) are the most commonly used modalities for interventional radiology procedures involving the breast. Computed tomography (CT) is rarely used for breast imaging yet it is able to detect breast lesions and can often provide safe and effective access to breast lesions. The aim of this study was to demonstrate situations in which CT should be considered as an alternative guidance method for the biopsy of breast lesions that are not accessible with conventional imaging modalities.

JOURNAL CLUB: Preparative Fasting for Contrast-Enhanced CT in a Cancer Center: A New Approach.

OBJECTIVE: Most diagnostic imaging centers ask patients to fast for 4-6 hours before contrast-enhanced CT. Previous studies have shown that prolonged fasting can be harmful. In addition, manufacturers of contrast agents claim that there is no special preparation needed before examination. The aim of this study was to evaluate the effects of preparative fasting on contrast-enhanced CT at a cancer center. SUBJECTS AND METHODS: Outpatients (n = 3206) were prospectively evaluated and randomly assigned to two groups: the 1619 patients in group 1 fasted for at least 4 hours before the examination, whereas the 1587 patients in group 2 received a light meal. Adverse symptoms observed before and after contrast agent administration were compared between groups. RESULTS: Adverse symptoms occurring after IV contrast agent administration were reported by 45 patients (1.5%) in group 1 and 30 patients (0.9%) in group 2. The most common symptoms were nausea (n = 32), weakness (n = 12), and vomiting (n = 5). The frequency of symptoms did not differ statistically significantly between groups (p > 0.05). CONCLUSION: In this sample of patients with cancer undergoing contrast-enhanced CT, very few adverse symptoms were reported regardless of preparative fasting. These results support the idea that preparation for contrast-enhanced CT can be simplified, decreasing the discomfort and inconvenience experienced by patients.

Relationship between anxiety and internet searches before percutaneous ultrasound-guided diagnostic procedures: A prospective cohort study.

Invasive procedures guided by ultrasound (US) are part of routine medical diagnostic investigation. The lack of knowledge surrounding the technical aspects of such procedures can lead patients to seek complementary information on the Internet, which may in turn trigger anxiety. However, the intersection between the fields of Radiology and Psychology is poorly studied. Here, we identify the profile of an anxious patient before an US-guided intervention. We prospectively studied 133 patients undergoing image-guided procedures. The State-Trait Anxiety Inventory (STAI) was applied for psychometry. Significantly higher anxiety scores were observed in female patients (p = .001), those who believed they had received inadequate information from their referring physician (p = .006), and in patients who considered online information unreliable or difficult to access (p = .007 and p = .001, respectively). Participants who defined themselves as proactive online reported lower anxiety levels (p = .003).

The usefulness of fine-needle aspirates for detection of recurrent carcinoma in the thyroid bed.

INTRODUCTION: Locoregional recurrence of thyroid carcinoma has a negative impact on patient prognosis. In the current study, we retrospectively reviewed cases of thyroid bed lesions in the last 3 years, correlating cytologic diagnoses with clinical findings and, whenever available, final surgical diagnosis. MATERIALS AND METHODS: Cytologic results and needle wash thyroglobulin results from patients with fine-needle aspiration (FNA) of thyroid bed lesions were retrospectively collected from our electronic files. Additional retrieved data included sex, age at diagnosis, previous thyroidectomy diagnosis, time lapse since surgery, and corresponding surgical diagnosis (whenever available). RESULTS: A total of 91 cases from 72 patients (54 F, 18 M) were retrieved from the electronic files, with a median age of 49 years. Average interval between surgery and thyroid bed FNA was 5 years. Thyroglobulin levels were available for 60 (65.2%) cases. The average level was 276.2 ug/mL, with a range of <0.1 to 4720 ug/mL. Information on final surgical diagnosis was available for 31 samples. Complete agreement between final cytologic and histologic diagnoses was achieved in 28 of 31 (90.3%) of the cases, with 1 false negative and 2 false positives. Cytology sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 95.2%, 71.4%, 90.9%, 83.3%, and 89.1%, respectively. CONCLUSIONS: Ultrasound-guided FNA is an accurate and minimally invasive diagnostic method for suspicious thyroid bed lesions, with high sensitivity and positive predictive value.

Computed tomography-guided percutaneous biopsy of abdominal lesions: indications, techniques, results, and complications.

OBJECTIVE: To evaluate the performance of computed tomography (CT)-guided percutaneous biopsy of abdominal lesions. MATERIALS AND METHODS: This retrospective, single-center study evaluated patients submitted to CT-guided percutaneous biopsy of abdominal lesions at a cancer center, between January 2014 and June 2015. The images and patient medical records were reviewed using a standardized data collection form. RESULTS: We included 225 procedures performed in 212 patients, of whom 143 (63.5%) had a prior diagnosis of cancer. Of the 225 lesions biopsied, 88 (39.1%) had a suspected primary origin and 137 (60.9%) were suspected metastatic lesions. Complications occurred in only 14 (6.2%), the most common being self-limited bleeding, which occurred in 12 (85.7%) of the 14. The occurrence of complications was not found to be significantly associated with the lesion location, age of the patient, presence of comorbidities, use of a supplementary technique, vascularization pattern, or proximity of the lesion to large vessels. The pathology findings were sufficient for making the diagnosis in 202 cases (89.8%), and the diagnosis was consistent with the clinical suspicion in 132 (58.6%). CONCLUSION: The procedure demonstrated a high (approximately 90%) rate of providing a sufficient sample for the diagnosis and a low complication rate, the most common complication being self-limiting bleeding.

Computed tomography-guided percutaneous biopsy of abdominal lesions: indications, techniques, results, and complications / Biópsia percutânea de lesões abdominais guiada por tomografia computadorizada: indicações, técnicas, resultados e complicações

Abstract Objective: To evaluate the performance of computed tomography (CT)-guided percutaneous biopsy of abdominal lesions. Materials and Methods: This retrospective, single-center study evaluated patients submitted to CT-guided percutaneous biopsy of abdominal lesions at a cancer center, between January 2014 and June 2015. The images and patient medical records were reviewed using a standardized data collection form. Results: We included 225 procedures performed in 212 patients, of whom 143 (63.5%) had a prior diagnosis of cancer. Of the 225 lesions biopsied, 88 (39.1%) had a suspected primary origin and 137 (60.9%) were suspected metastatic lesions. Complications occurred in only 14 (6.2%), the most common being self-limited bleeding, which occurred in 12 (85.7%) of the 14. The occurrence of complications was not found to be significantly associated with the lesion location, age of the patient, presence of comorbidities, use of a supplementary technique, vascularization pattern, or proximity of the lesion to large vessels. The pathology findings were sufficient for making the diagnosis in 202 cases (89.8%), and the diagnosis was consistent with the clinical suspicion in 132 (58.6%). Conclusion: The procedure demonstrated a high (approximately 90%) rate of providing a sufficient sample for the diagnosis and a low complication rate, the most common complication being self-limiting bleeding.

Resumo Objetivo: Avaliar a performance das biópsias percutâneas de lesões abdominais guiadas por tomografia computadorizada (TC). Materiais e Métodos: Estudo retrospectivo, unicêntrico, com pacientes submetidos a biópsias percutâneas de lesões abdominais guiadas por TC em um centro de referência oncológico, no período de janeiro de 2014 a junho de 2015. Foram avaliados as imagens dos procedimentos e os prontuários dos pacientes, sendo preenchida uma ficha de coleta de dados padronizada. Resultados: Foram incluídos 225 procedimentos em 212 pacientes, dos quais 143 (63,5%) tinham história prévia de câncer. Das lesões submetidas a biópsia, 88 (39,1%) apresentavam suspeita de lesão primária e 137 (60,9%), de lesão metastática. Apenas 14 (6,2%) lesões evoluíram com alguma complicação, sendo a mais comum o sangramento autolimitado (n = 12; 85,7%). Todos os procedimentos foram realizados com técnica coaxial. Não houve diferença na incidência de complicações em relação a localização da lesão, idade, comorbidades, técnica utilizada, padrão de vascularização e proximidade de grandes vasos. O resultado do exame patológico foi suficiente para o diagnóstico em 89,8% (202) do total. O diagnóstico foi concordante com a suspeita em 58,6% dos casos. Conclusão: Os resultados demonstraram um índice de amostra suficiente para o diagnóstico de aproximadamente 90%, com uma taxa de complicação pequena, sendo a mais frequente o sangramento autolimitado.