[Transbronchial lung cryobiopsy in interstitial lung diseases]. / Les cryobiopsies pulmonaires transbronchiques dans les pneumopathies infiltrantes diffuses.

In some cases of interstitial lung disease (ILD), clinical and biological findings associated with CT scan pattern during multidisciplinary discussion (MDD) fail to yield a confident diagnosis. In these cases, histology may be necessary. Transbronchial lung cryobiopsy (TBLC) is a bronchoscopic procedure that has been developed in recent years and currently contributes to diagnostic work-up in patients with ILD. TBLC provides tissue samples for histological analysis with an acceptable risk of complications, consisting mainly in pneumothorax or bleeding. In addition to higher diagnostic yield than conventional forceps biopsies, the procedure shows a better safety profile than surgical biopsies. The indication to perform TBLC is decided during a 1st MDD and during a 2nd MDD, results can provide a diagnostic yield approximating 80%. TBLC appears to be an attractive, minimally invasive technique to be proposed as a first-line procedure in selected patients in experienced centers, while surgical lung biopsy may be considered as a second-line solution.

Percutaneous CT-guided lung biopsy for the diagnosis of persistent pulmonary consolidation.

PURPOSE: The primary objective of this study was to determine the diagnostic accuracy of percutaneous computed tomography (CT)-guided biopsy of persistent pulmonary consolidations. The secondary objective was to determine the complication rate and identify factors affecting diagnostic yield. MATERIALS AND METHODS: Two radiologists retrospectively reviewed 98 percutaneous CT-guided biopsies performed in 93 patients (60 men, 33 women; mean age, 62±14.0 (SD) years; range: 18-88 years) with persistent pulmonary consolidations. Final diagnoses were based on surgical outcomes or 12 months clinical follow-up findings. Biopsy results were compared to the final diagnosis to estimate diagnostic yield. RESULTS: A final diagnosis was obtained for all patients: 51/93 (54.8%) had malignant lesions, 12/93 (12.9%) specific definite benign lesions (including 9 infections, two pneumoconiosis and one lipoid pneumonia) and 30/93 (32.3%) non-specific benign lesions. CT-guided biopsy had an overall diagnostic yield of 60% (59/98) with a correct diagnosis for 50/51 malignant lesions (diagnostic yield of 98% for malignancy) and for 9/47 benign lesions (diagnostic yield of 19% for benign conditions). Major complications occurred in 4/98 (4%) of lung biopsies (four pneumothoraxes requiring chest tube placement). CONCLUSION: Percutaneous CT-guided biopsy is an alternative to endoscopic or surgical biopsy for the diagnosis of persistent consolidation with a low risk of severe complication.

Pancreatic carcinoma: Key-points from diagnosis to treatment.

Pancreatic ductal carcinoma is one of the deadliest cancers in the world. The only hope for prolonged survival still remains surgery with complete R0 resection even if most patients will promptly develop metastases and/or local relapses. Due to the silent nature of the disease, fewer than 20% of patients are eligible for a curative-intent resection. As no gain in survival is expected in case of residual tumor, imaging plays a major role for diagnosis and staging to select patients who will undergo surgery. Multidetector-row computed tomography and magnetic resonance imaging are the key stones and radiologists must be aware of imaging protocols, standardized terms and critical points for structured reporting to assess the tumor staging, minimize potential the morbidity associated with surgery and offer patients the best therapeutic strategy.

A solid pancreatic mass: tumour or inflammation?

The prognosis for pancreatic cancer is poor, and early diagnosis is essential for surgical management. By comparison with its classic form, the presence of acute or chronic inflammatory signs will hinder its detection and delay its diagnosis. The atypical forms of acute pancreatitis need to be known in order to detect patients who require additional morphological investigations to search for an underlying tumour. In contrast, pseudotumoral forms of inflammation (chronic pancreatitis, cystic dystrophy in heterotopic pancreas, autoimmune pancreatitis) may simulate a cancer, and make up 5-10% of the surgical procedures for suspected cancer. Faced with these pseudotumoral masses, interpretation relies on various differentiating signs and advances in imaging.

Long-term follow-up of percutaneous vena cava filters: a prospective study in 100 consecutive patients.

OBJECTIVES: the long-term outcome in following insertion of inferior vena cava (IVC) filters remains unclear. DESIGN: prospective study. MATERIAL AND METHODS: one hundred consecutive patients received percutaneous vena cava filters between 1988 and 1993. The patients underwent clinical examination, abdominal X-rays and duplex ultrasound of the IVC, right internal jugular vein and legs after a mean follow-up duration of 38+/-11 months. RESULTS: forty patients died after implantation (median 11.3 months; IQR: 1.8--20.4 months). The cause of death was known in 33 cases, and pulmonary embolism (PE) was suggested in three. Multivariate analysis revealed the mortality rate to be significantly higher in cancer patients (relative risk of 2.13). The 3-year survival was 20% for cancer patients and 71% for patients without cancer. Among the 60 living patients, thrombi were trapped in the filter in 10 cases, the filter tilted in four, was malpositioned in five and migrated in 29. These incidents were recorded as asymptomatic complications, as opposed to seven IVC thromboses and 23 recurrent lower limb thromboses, which were considered as symptomatic complications. CONCLUSION: long-term major complications are not frequent. As expected, cancer was the only factor predicting mortality. IVC filters seem effective in preventing PE.