Computed Tomography-Guided Tru-Cut Biopsy in the Diagnosis of Lung Lesions; Our Clinical Experience.

INTRODUCTION: CT-guided tru-cut biopsy, which is less invasive and cost-effective, is an important diagnostic tool with high accuracy in lesions located peripherally in the lung. In this article, CT-guided tru-cut biopsy experiences of thoracic surgeons are shared. MATERIALS AND METHODS: CT-guided tru-cut biopsy was performed on 200 patients with suspected lung lesions in the thoracic surgery clinic. Diagnostic rates of biopsies, complications, factors affecting the development of complications, and complication management were examined. RESULTS: The diagnostic rate of the biopsies was 88%. Pneumothorax developed in 19.5% and hemothorax in 1% after the procedure. There was a significant relationship between mass dimensions and total complication rates (p=0.017). The relationship between the distance among the pleura and the mass and the development of complications was significant (p<0.001). The relationship between the number of biopsies and the development of pneumothorax was significant (p=0.011). The relationship between the size of the mass and the development of pneumothorax was significant (p=0.011). In univariate binary logistic regression analysis, a significant correlation was found between the size of the mass and the development of total complications (odds ratio (OR)=0.356 (95% CI: (0.146-0.868), (p=0.023)). DISCUSSION: In the diagnosis of lung lesions, CT-guided tru-cut biopsy is an effective diagnostic tool with high diagnostic power, with its less invasiveness, and lower cost. The increase in the lung parenchyma distance passed with the biopsy needle increased the likelihood of complications most significantly. The size of the mass and the number of biopsies also had significant effects on the development of complications.

Accuracy of Metabolic Imaging-guided Transthoracic Biopsy in Lung Cancer.

OBJECTIVE: To compare the detection of transthoracic tru-cut biopsy performed on metabolically active areas in positron emission tomography (PET) for the diagnosis of lung cancer, compared to only CT scan-guided biopsy. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Thoracic Surgery, Kayseri City Training and Research Hospital, Turkey, between December 2020 to June 2021. METHODOLOGY: Patients of suspected lung cancer with pre-transthoracic biopsy chest computerised tomography and without positron emission tomography were included in Group A; while, patients with both and positron emission tomography chest computerised tomography were included in Group B. Based on the CT findings of the patients in Group A, a biopsy was obtained from the most appropriate place. The patients in Group B were evaluated by a nuclear medicine specialist and the place with the highest maximum standardised uptake value before the biopsy was marked and the area to be biopsied was determined. RESULTS: The malignancy detection rate was significantly higher in Group B (48/50 patients, 96%) than in Group A (36/50 patients, 72%, p=0.001). Two lesions in the Group B (4 %) and 14 lesions in the Group A (28 %) were found to give benign results (p=0.001). Biopsy was repeated in one patient of Group B, and in five patients of Group A due to an initial negative diagnosis. The sensitivity of PET/CT in predicting malignant tumor was 96%, with the positive predictive value (PPV) of 98.0%; while the sensitivity of CT was 74.5%, with PPV of 82%. CONCLUSION: Transthoracic biopsies taken by considering metabolically active areas of the mass in positron emission tomography-guided can both increase diagnosis rate and reduce the complication rate by preventing repeated biopsies. Key Words: Transthoracic biopsy, PET/CT, Metabolic active lesion, Malignant tumor.

The role of telomerase in the etiology of primary spontaneous pneumothorax.

BACKGROUND: This study aims to investigate the role of telomerase activity in the risk of primary spontaneous pneumothorax, which is most frequently encountered in the practice of thoracic surgery. METHODS: A total of 61 patients (56 males, 5 females; median age: 29.4 years; range, 17 to 43 years) who underwent treatment for primary spontaneous pneumothorax and 19 age- and sex-matched healthy controls (10 males, 9 females; median age: 29.1 years; range, 23 to 43 years) were included in this prospective study between January 2018 - August 2018. Telomerase activity was evaluated with enzyme-linked immunosorbent assay. The correlation between telomerase activity and clinical and demographic parameters was examined. RESULTS: The mean serum telomerase level was 3.4±0.6 ng/mL in the primary spontaneous pneumothorax group and 1.9±0.5 ng/mL in the control group, indicating significantly higher levels in the patient group (p<0.001). There was no significant association between the telomerase levels and presence of blebs and/or bullae on thoracic computed tomography, extent of pneumothorax, laterality (right, left, or bilateral), and pack years of cigarette smoking. CONCLUSION: Telomerase levels of patients with primary spontaneous pneumothorax are significantly higher than healthy individuals. Future genetic studies may ultimately clarify a potential relationship between primary spontaneous pneumothorax and short telomere syndrome.

T-Cell Lymphoma Presenting With Bilateral Chylothorax.

Chylothorax is the accumulation of chyle in the pleural cavity due to obstruction or injury arising in the thoracic duct or its large branches. In more than 50% of patients diagnosed with chylothorax, the etiology consists of malignant diseases; and among these, lymphomas are the most common cause, accounting for 60% of cases. We report a case of a 37-year male with T-cell lymphoma who presented with bilateral pleural effusion; pleural fluid analysis confirmed chylothorax. A solid lymph node was detected in the left zone 4 on neck ultrasonography. Tru-cut biopsy was done and reported as T-cell lymphoma. The cytology was consistent with Class V (Malignant) T-cell lymphoma infiltration. Bilateral chylothorax, a complication of T-cell lymphoma, is a rare presentation of this disease. Our patient was diagnosed rapidly with both chylothorax and lymphoma. We started the treatment immediately and saved his life. Key Words: Chyle, Chylothorax, Lymphoma.

Computed tomography-guided transthoracic biopsy: Factors influencing diagnostic and complication rates.

Objective This study was performed to assess the complication and diagnostic rates of computed tomography (CT)-guided transthoracic needle biopsy of pulmonary parenchymal and mediastinal lesions. Methods Patients who were suspected to have a malignancy based on chest imaging and CT and could not be otherwise diagnosed were evaluated. Results Sixty-five patients were included; 48 (73.8%) were male and 17 (26.2%) were female. Their average age was 58 years. The lesion size ranged from 11 to 105 mm. The most common specific histologic subtype was adenocarcinoma, and the least common was lymphoma. The diagnostic rate was 90.8%. The mean complication rate was 15.4%. Statistically significant associations were found between the complication rate and needle size and between the needle path length and lesion size. Conclusion CT-guided needle biopsy is an effective diagnostic method for patients with mediastinal and parenchymal lesions before thoracotomy. This method can also reliably differentiate benign and malignant tumors.

[Case report: secondary pleural hydatidosis].

Hydatid cyst has a predilection to locate in liver, lungs, and brain. Intrathoracic extrapulmonary locations are generally the mediastinum, pleura, pericardium and chest wall. Pleural involvement usually follows the rupture of a pulmonary or hepatic cyst inside the pleural space causing secondary pleural hydatidosis. Radiological investigations of a patient suffering from cough and dyspnea revealed multiple cysts located in the posterior lower right hemithorax, and implanted in the diaphragmatic pleura and parietal pleura lining the chest wall. He had undergone two hepatic hydatid cystectomy operations. These multiple cysts were removed by thoracotomy. The possibility of secondary pleural dissemination should be considered in patients with lobulated cystic masses as well as a previous hepatic cystic hydatid disease.

Case report: mediastinal hydatid cysts.

Although the intrathoracic location is common for hydatid cyst, chest-wall, mediastinal, pericardial, myocardial, fissural and pleural-space locations have been reported. The incidence of mediastinal involvement is 0.1-0.5%. Here in this paper, two cases of mediastinal hydatid cysts are reported. Both of them had anterior mediastinal hydatidosis, while one of the patients had also additional three pericardial hydatid cysts. They have undergone thoracotomy for the removal of cystic lesions. Hydatid cysts should be considered in the differential diagnosis of mediastinal cystic lesions especially in the endemic regions. Surgical removal is the treatment of choice for mediastinal hydatid cysts, and additional medical therapy may avoid recurrence.