RESUMO
PURPOSE: Transperineal prostate biopsy (TPB) offers an alternative to transrectal prostate biopsy (TRB) for prostate cancer diagnosis. However, TPB may result in additional disposable and capital equipment costs, which can limit implementation within urology practice. Herein, we report the initial experience of a novel TPB technique within a tertiary referral center in Taiwan. MATERIALS AND METHODS: A retrospective review of all men undergoing prostate biopsy January to October in 2021 was performed. Both biopsy techniques were performed with the same setting using the convex-convex array ultrasound probe under local anesthesia alone or with the addition of sedation using double free-hand technique. Complications within 30 days and cancer detection rate (CDR) were compared between the groups. RESULTS: A total of 118 biopsies were included for final analysis. Eleven patients received systematic biopsy with additional MRI-targeted biopsy (TB) cores with all performed via a transperineal approach. The TPB group (n = 47) and TRB group (n = 58) had similar CDR after excluding TB cores (46.8% vs. 44.8%, p = 0.675). General complication rates for TPB were significantly lower than in the TRB group (27.7% vs. 46.6%, p = 0.047). No patients undergoing TPB had infectious complications, where five episodes were recorded in the TRB group (p = 0.114). CONCLUSIONS: TPB performed with convex-convex ultrasound probe and double free-hand technique is safe, feasible, cost-effective, and demonstrates equivalent CDR to TRB. Its use may eliminate infectious hospitalizations while minimizing the need for additional capital in the adoption of TPB.
Assuntos
Próstata , Neoplasias da Próstata , Masculino , Humanos , Próstata/diagnóstico por imagem , Próstata/patologia , Análise Custo-Benefício , Biópsia/efeitos adversos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Ultrassonografia , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodosRESUMO
AIM: To compare the success and complication rates of computed tomography (CT)-guided percutaneous core-needle biopsy (PCNB) based on the density of lung nodules, using propensity score matching (PSM). MATERIALS AND METHODS: This single-centre retrospective study included 1,312 PCNB cases of lung lesions, including solid (n=1,120), part-solid (n=115), and non-solid nodules (n=77), that were detected between March 2013 and March 2021. The diagnostic accuracy and complication rates of pneumothorax and pulmonary haemorrhage were analysed before PSM. To perform PSM, part-solid and non-solid nodules were combined and newly defined as sub-solid nodules. The diagnostic accuracy and complication rates of pneumothorax and pulmonary haemorrhage were then compared between solid and sub-solid nodules after PSM. RESULTS: Among the 1,312 included cases, the success rate and incidence of pneumothorax after CT-guided PCNB for solid, part-solid, and non-solid nodules were not statistically different (p=0.080 and 0.410). However, the rates of overall pulmonary haemorrhage showed statistical differences (p<0.001), particularly between solid and part-solid nodules (p<0.001) and between solid and non-solid nodules (p<0.001). After PSM, the incidence rates of overall pulmonary haemorrhage in solid and sub-solid nodules were 8.9% (17/192) and 29.7% (44/182), respectively, showing a statistically significant difference (p<0.001). CONCLUSION: There is increased risk of haemorrhage in CT-guided needle biopsy of sub-solid nodules compared to solid nodules. Increased emphasis should be placed on the risk of pulmonary haemorrhage when consenting these patients.
Assuntos
Pneumopatias , Neoplasias Pulmonares , Pneumotórax , Humanos , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Neoplasias Pulmonares/diagnóstico por imagem , Estudos Retrospectivos , Pontuação de Propensão , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodos , Biópsia com Agulha de Grande Calibre/efeitos adversos , Hemorragia/epidemiologia , Hemorragia/etiologia , Tomografia Computadorizada por Raios X , Pulmão/diagnóstico por imagem , Pulmão/patologiaRESUMO
OBJECTIVE: To elucidate regional trends of infectious complications following transrectal ultrasound prostate biopsy (TRUS-PB) from a national, privately-insured database. MATEREIAL AND METHODS: Using Market Scan, we identified all men who underwent TRUS-PB from 2010 to 2015. Infectious complications (UTI, prostatitis, sepsis) occurring 30 days after the prostate biopsy from emergency room (ER) visits or hospital admissions constituted the primary outcomes. We analyzed unadjusted and adjusted rates of infectious complications from ER visits and hospital admissions per 100 prostate biopsies by state. Multivariable logistic regression analyses were used to identify patient covariates associated with infectious complications. RESULTS: During the study interval, we identified 193,490 patients who underwent TRUS-PB. The mean age was 57.6 years (SD: 5.0). Over time the unadjusted national rates of infectious complications remained similar from 0.4 ER visits per 100 prostate biopsies in 2010 -0.2 in 2015 (Pâ¯=â¯0.83), and 1.2 hospital admissions per 100 prostate biopsies in 2010 to 1.1 in 2015 (P= 0.58). Connecticut had the lowest unadjusted infectious complication rate per 100 biopsies at 0.64, whereas West Virginia had the highest at 2.34. Multivariable analysis revealed higher Elixhauser status and patient age were associated with higher odds of infectious complications (P<0.05). CONCLUSIONS: While rates of infectious complications attributable to prostate biopsies remain relatively stable, significant variation exists at the state level regarding this adverse outcome.
Assuntos
Próstata , Neoplasias da Próstata , Humanos , Masculino , Estados Unidos/epidemiologia , Pessoa de Meia-Idade , Próstata/patologia , Neoplasias da Próstata/patologia , Biópsia/efeitos adversos , Biópsia/métodos , Estudos de Coortes , Seguro Saúde , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodosRESUMO
Background Percutaneous CT-guided biopsy of lung nodules is an established method with high diagnostic accuracy but a high rate of pneumothorax and chest tube insertion compared with endobronchial methods. Purpose To investigate the effect of a protocol combining patient positioning biopsy-side down, needle removal during expiration, autologous blood patch sealing, rapid rollover, and pleural patching (PEARL) on complication rate after percutaneous CT-guided lung biopsy, especially chest tube insertion. Materials and Methods In a secondary analysis of both prospectively and retrospectively acquired data from December 2019 to November 2020, consecutive participants underwent biopsy with use of the PEARL protocol (prospective data) and were compared with patients who underwent biopsy at the same tertiary cancer center according to the standard method without any additional techniques (controls, retrospective data). Patient demographics, lesion characteristics, intraprocedural data, complications, and histologic results were recorded and compared. Results One hundred patients in the control group (mean age ± standard deviation, 63 years ± 12; 61 men) and 100 participants in the PEARL group (mean age, 64 years ± 12; 48 men) were evaluated. No differences were found in patient and lesion characteristics. The emphysema rate was 47 of 100 patients (47%) in both groups. The rate of pneumothorax was 37 of 100 patients (37%) in the control group versus 16 of 100 (16%) in the PEARL group (P = .001). Of the pneumothoraxes that occurred, fewer were during the intervention in the PEARL group, with 21 of 37 onsets (57%) in the control group versus three of 16 onsets (19%) in the PEARL group (P < .001). A chest tube was inserted in 13 of 100 patients (13%) in the control group and only in one of 100 (1%) in the PEARL group (P = .002). Histologic findings were diagnostic in 94 of 100 patients (94%) in the control group and 95 of 100 (95%) in the PEARL group (P > .99). Conclusion During CT-guided percutaneous lung biopsy, a protocol of positioning biopsy-side down, needle removal during expiration, autologous blood patch sealing, rapid rollover, and pleural patching, or PEARL, reduced rates of pneumothorax and chest tube insertion. © RSNA, 2021.
Assuntos
Biópsia Guiada por Imagem/efeitos adversos , Neoplasias Pulmonares/patologia , Radiografia Intervencionista , Tomografia Computadorizada por Raios X , Placa de Sangue Epidural , Tubos Torácicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Pneumotórax/etiologia , Estudos Prospectivos , Estudos RetrospectivosRESUMO
INTRODUCTION: Lung cancer is accountable for 35 000 deaths annually, and prognosis is improved when the cancer is diagnosed early. CT-guided biopsy (transthoracic needle aspiration, TTNA) and electromagnetic navigation bronchoscopy (ENB) can be used to investigate indeterminate pulmonary nodules if the patient is unfit for surgery. However, there is a paucity of clinical and health economic evidence that directly compares ENB with TTNA in this population group. This cost-effectiveness study aimed to explore potential scenarios whereby ENB may be considered cost-effective when compared with TTNA. METHODS: A cohort decision analytic model was developed using a UK National Health Service perspective. ENB was assumed to have equal sensitivity to TTNA at 82%. Lifetime costs and quality-adjusted life-year (QALY) gain were calculated to estimate the net monetary benefit at a £20 000 per QALY threshold. Sensitivity analyses were used to explore scenarios where ENB could be considered a cost-effective intervention. RESULTS: Under the assumption that ENB has equal efficacy to TTNA, ENB was found to be dominant (less costly and more effective) when compared with TTNA, due to having a reduced risk and cost of adverse events. This conclusion was most sensitive to changes in the cost of intervention, estimates of effectiveness and adverse event rates. DISCUSSION: ENB is expected to be cost-effective when the likelihood of an accurate diagnosis is equal to (or better than) TTNA, which may occur in certain subgroups of patients in whom TTNA is unlikely to accurately diagnose malignancy or when an experienced practitioner achieves a high accuracy with ENB.
Assuntos
Análise Custo-Benefício , Fenômenos Eletromagnéticos , Neoplasias Pulmonares/patologia , Nódulos Pulmonares Múltiplos/patologia , Biópsia por Agulha Fina/efeitos adversos , Broncoscopia/efeitos adversos , Feminino , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Neoplasias Pulmonares/economia , Masculino , Nódulos Pulmonares Múltiplos/economia , Medicina Estatal , Tomografia Computadorizada por Raios X , Reino UnidoRESUMO
BACKGROUND: The Japan Society for Respiratory Endoscopy performed a nationwide survey to evaluate the current status and complications of bronchoscopy. Data on deaths due to bronchoscopy, complications after bronchoscopy, and particularly, complications of forceps biopsy were surveyed. METHODS: The survey form was mailed to 532 facilities accredited by the society. The numbers of procedures, complications, and deaths were investigated. RESULTS: The response rate was 79.1% (421 facilities). Deaths attributable to diagnostic bronchoscopy occurred in 11 (0.011%) of 98,497 cases.In regards to forceps biopsy, the guide sheath method was applied in 23,916 cases and the conventional method in 31,419 cases was done with conventional method. Complications of forceps biopsy developed in 1019 cases in total, with an incidence rate of 1.84%. The most frequent complication was pneumothorax (0.70%), followed by pneumonia/pleurisy (0.46%) and hemorrhage (0.45%). The incidence of hemorrhagic complication was significantly lower in the guide sheath group than in the non-guide sheath group (0.29% vs. 0.58%; P<0.001). The overall incidence of complications (1.63% vs. 2.00%; P=0.002) and the mortality rate (0% vs. 0.02%; P=0.04) were significantly lower in the guide sheath group. CONCLUSION: The incidence of hemorrhagic complications in forceps biopsy of peripheral pulmonary lesions was lower when the guide sheath method was applied. It is necessary to increase the awareness for safety control in diagnostic bronchoscopy for new procedures.
Assuntos
Broncoscopia/efeitos adversos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/instrumentação , Hemorragia/epidemiologia , Biópsia Guiada por Imagem/efeitos adversos , Neoplasias Pulmonares/patologia , Instrumentos Cirúrgicos/efeitos adversos , Broncoscopia/métodos , Broncoscopia/mortalidade , Broncoscopia/estatística & dados numéricos , Endoscopia , Hemorragia/etiologia , Hemorragia/mortalidade , Humanos , Incidência , Japão , Mortalidade/tendências , Pleurisia/epidemiologia , Pleurisia/etiologia , Pneumonia/epidemiologia , Pneumonia/etiologia , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Estudos Retrospectivos , Sociedades Médicas/organização & administração , Inquéritos e Questionários/estatística & dados numéricosRESUMO
OBJECTIVES: To compare the efficacy, safety and cost of combinations of perineal pudendal nerve block + periprostatic nerve block and intrarectal local anesthesia + periprostatic nerve block with the standard technique (periprostatic nerve block). METHODS: The study was designed as a randomized prospective controlled trial. Patients with elevated serum prostate-specific antigen values (prostate-specific antigen ≥4 ng/mL) and/or abnormal digital rectal examination findings were included in the study. Patients with anorectal diseases, chronic prostatitis, previous history of prostate biopsy and anorectal surgery were excluded from the study. A total of 148 patients (group 1 [periprostatic nerve block], n = 48; group 2 [intrarectal local anesthesia + periprostatic nerve block], n = 51; group 3 [perineal pudendal nerve block + periprostatic nerve block], n = 49) were included in the final analysis. Pain during insertion and manipulation of the transrectal ultrasound probe was recorded as visual analog scale 1, pain during penetration of the biopsy needle into the prostate and sampling was recorded as visual analog scale 2, and pain during the entire procedure recorded as visual analog scale 3. RESULTS: The mean visual analog scale 1 score was significantly lower in group 3, when compared with group 1 and group 2 (P < 0.001). There was no significant difference between the groups in terms of the mean visual analog scale 2 score. The mean visual analog scale 3 score was significantly lower in group 3 when compared with other groups (P < 0.001). The total cost for transrectal ultrasound-guided biopsy in the intrarectal local anesthesia + periprostatic nerve block group was significantly higher than the other two groups. CONCLUSIONS: The combination of perineal pudendal nerve block and periprostatic nerve block provides more effective pain control than intrarectal local anesthesia plus periprostatic nerve block and periprostatic nerve block alone, with similar complication rates and without increasing cost.
Assuntos
Anestesia Local/métodos , Bloqueio Nervoso/métodos , Dor Processual/prevenção & controle , Neoplasias da Próstata/diagnóstico , Idoso , Anestesia Local/efeitos adversos , Anestesia Local/economia , Anestésicos Locais/administração & dosagem , Anestésicos Locais/economia , Biópsia com Agulha de Grande Calibre/efeitos adversos , Biópsia com Agulha de Grande Calibre/economia , Biópsia com Agulha de Grande Calibre/métodos , Análise Custo-Benefício , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/economia , Biópsia Guiada por Imagem/métodos , Lidocaína/administração & dosagem , Lidocaína/economia , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/economia , Medição da Dor/estatística & dados numéricos , Dor Processual/diagnóstico , Dor Processual/etiologia , Próstata/diagnóstico por imagem , Próstata/patologia , Neoplasias da Próstata/patologia , Nervo Pudendo/efeitos dos fármacos , Reto/cirurgia , Ultrassonografia de Intervenção/economiaRESUMO
BACKGROUND: Prostate cancer risk prediction models and multiparametric magnetic resonance imaging (mpMRI) are used for individualised pre-biopsy risk assessment. However, biparametric MRI (bpMRI) has emerged as a simpler, more rapid MRI approach (fewer scan sequences, no intravenous contrast-media) to reduce costs and facilitate a more widespread clinical implementation. It is unknown how bpMRI and risk models perform conjointly. Therefore, the objective was to develop a predictive model for significant prostate cancer (sPCa) in biopsy-naive men based on bpMRI findings and clinical parameters. METHODS: Eight hundred and seventy-six biopsy-naive men with clinical suspicion of prostate cancer (prostate-specific antigen, <50 ng/mL; tumour stage, Assuntos
Tomada de Decisão Clínica/métodos
, Imageamento por Ressonância Magnética Multiparamétrica/métodos
, Nomogramas
, Próstata/diagnóstico por imagem
, Neoplasias da Próstata/diagnóstico
, Idoso
, Biópsia com Agulha de Grande Calibre/efeitos adversos
, Biópsia com Agulha de Grande Calibre/normas
, Reações Falso-Negativas
, Humanos
, Biópsia Guiada por Imagem/efeitos adversos
, Biópsia Guiada por Imagem/normas
, Calicreínas/sangue
, Masculino
, Pessoa de Meia-Idade
, Gradação de Tumores
, Período Pré-Operatório
, Próstata/patologia
, Antígeno Prostático Específico/sangue
, Neoplasias da Próstata/sangue
, Neoplasias da Próstata/patologia
, Padrões de Referência
, Medição de Risco/métodos
, Ultrassonografia de Intervenção
RESUMO
PURPOSE: To report types and outcomes of a small subset of malpractice lawsuits filed against physicians performing image-guided interventions in the United States. MATERIALS AND METHODS: In total, 1,312 cases involving common image-guided procedures were reviewed from the Westlaw and LexisNexis databases in the United States from 1963 to 2018. Social Security, disability, employment contract, product liability, criminal, and government employment claims were excluded. The final legal cohort comprised 184 (14.0%) cases. They were categorized into vascular (113/184; 61.4%), inferior vena cava filter (n = 22; 12.0%), neurointerventional (n = 13; 7.1%), gastrointestinal and genitourinary (n = 17; 9.2%), foreign body (n = 7; 3.8%), biopsy related (n = 9; 4.9%), and oncologic (n = 3; 1.6%) interventions. Claims were also organized by defendant type and by specialty, complication stage, verdict, and year. RESULTS: From 2001 to 2018, 58.7% of claims (n = 108) were reported. Procedural complications related to arteriography were most commonly litigated (63/113; 55.8%). Claims arising from intra-procedural and early post-procedural complications were common (84/184; 45.7%). Community hospitals were most often named as defendants (61/184; 33.2%). In reported outcomes, courts sided with defendants in 81.9% (104/127) of the cases, similar to national malpractice trends. Unreported outcomes comprised 31% (57/184) of the data. CONCLUSIONS: For the small subset of claims published within national legal databases, intra-procedural and early post-procedural complications after diagnostic arteriography were most commonly litigated. Most (81.9%) claims with reported outcomes sided with the defendant physician.
Assuntos
Biópsia Guiada por Imagem/efeitos adversos , Responsabilidade Legal , Imperícia/legislação & jurisprudência , Segurança do Paciente/legislação & jurisprudência , Radiografia Intervencionista/efeitos adversos , Radiologistas/legislação & jurisprudência , Bases de Dados Factuais , Humanos , Medição de Risco , Fatores de RiscoRESUMO
OBJECTIVE: Using a hydrogel plug decreases the number of cases of pneumothorax and reduces the need for pleural drainage tubes in CT-guided lung biopsies. We aimed to analyze the cost-effectiveness of using hydrogel plugs. MATERIAL AND METHODS: We analyzed 171 lung biopsies divided into three groups: Group 1 (n=22): fine-needle aspiration cytology (FNAC) without hydrogel plugs; Group 2 (n=89): FNAC with hydrogel plugs; and Group 3 (n=60): FNAC plus core-needle biopsy (CNB) with hydrogel plugs. We calculated the total costs (direct and indirect) in the three groups. We analyzed the percentage of correct diagnoses, the average and incremental rations, and the most cost-effective option. RESULTS: Total costs: Group 1 = 1,261.28 + 52.65 = 1,313.93; Group 2 = 1,201.36 + 67.25 = 1,268.61; Group 3 = 1,220.22 + 47.20 = 1,267.42. Percentage of correct diagnoses: Group 1 = 77.3%, Group 2 = 85.4%, and Group 3 = 95% (p = 0.04). Average cost-effectiveness ratio: Group 1 = 16.99; Group 2 = 14.85; and Group 3 = 13.34. CONCLUSIONS: Group 3 was the best option, with the lowest average cost-effectiveness ratio; therefore, the most cost-effective approach is to do FNAC and CNB using a dehydrated hydrogel plug at the end of the procedure.
Assuntos
Hidrogéis/economia , Biópsia Guiada por Imagem/economia , Pulmão/patologia , Pneumotórax/prevenção & controle , Idoso , Análise de Variância , Biópsia por Agulha Fina/efeitos adversos , Biópsia por Agulha Fina/economia , Biópsia com Agulha de Grande Calibre/efeitos adversos , Biópsia com Agulha de Grande Calibre/economia , Tubos Torácicos , Análise Custo-Benefício , Custos Diretos de Serviços , Feminino , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/estatística & dados numéricos , Renda , Tempo de Internação , Masculino , Pneumotórax/etiologia , Estudos Retrospectivos , Fatores Sexuais , Tomografia Computadorizada por Raios X , Técnicas de Fechamento de Ferimentos/economiaAssuntos
Hipnóticos e Sedativos/uso terapêutico , Biópsia Guiada por Imagem , Pulmão/patologia , Midazolam/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Ansiedade/prevenção & controle , Ansiedade/psicologia , Biópsia por Agulha Fina/efeitos adversos , Biópsia por Agulha Fina/psicologia , Estudos de Casos e Controles , Feminino , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/psicologia , Masculino , Pessoa de Meia-Idade , Dor Processual/etiologia , Dor Processual/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Inquéritos e Questionários , Ultrassonografia de IntervençãoRESUMO
PURPOSE OF REVIEW: To review the current literature regarding the role of multiparametric MRI and fusion-guided biopsies in urologic practice. RECENT FINDINGS: Fusion biopsies consistently show an increase in the detection of clinically significant cancers and decrease in low-risk disease that may be more suitable for active surveillance. Although, when to incorporate multiparametric MRI into workup is not clearly agreed upon, studies have shown a clear benefit in both biopsy naïve and those with prior negative biopsies in determining the appropriate treatment strategy. More recently, cost-analysis models have been published that show that upfront MRIs are more cost-effective when considering missed cancers and treatment courses. SUMMARY: With improved accuracy over systematic biopsies, fusion biopsies are a superior method for detection of the true grade of cancer for both biopsy naïve and patients with prior negative biopsies, choosing appropriate candidates for active surveillance, and monitoring progression on active surveillance.
Assuntos
Biópsia com Agulha de Grande Calibre/métodos , Biópsia Guiada por Imagem/métodos , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Biópsia com Agulha de Grande Calibre/efeitos adversos , Biópsia com Agulha de Grande Calibre/economia , Análise Custo-Benefício , Reações Falso-Negativas , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/economia , Imagem por Ressonância Magnética Intervencionista/métodos , Masculino , Imagem Multimodal/economia , Imagem Multimodal/métodos , Seleção de Pacientes , Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Ultrassonografia de Intervenção/economia , Ultrassonografia de Intervenção/métodos , Conduta Expectante/economia , Conduta Expectante/métodosRESUMO
PURPOSE: To describe the incidence and type of brachytherapy patient safety events over 10 years in an academic brachytherapy program. METHODS AND MATERIALS: Brachytherapy patient safety events reported between January 2007 and August 2016 were retrieved from the incident reporting system and reclassified using the recently developed National System for Incident Reporting in Radiation Treatment taxonomy. A multi-incident analysis was conducted to identify common themes and key learning points. RESULTS: During the study period, 3095 patients received 4967 brachytherapy fractions. An additional 179 patients had MR-guided prostate biopsies without treatment as part of an interventional research program. A total of 94 brachytherapy- or biopsy-related safety events (incidents, near misses, or programmatic hazards) were identified, corresponding to a rate of 2.8% of brachytherapy patients, 1.7% of brachytherapy fractions, and 3.4% of patients undergoing MR-guided prostate biopsy. Fifty-one (54%) events were classified as actual incidents, 29 (31%) as near misses, and 14 (15%) as programmatic hazards. Two events were associated with moderate acute medical harm or dosimetric severity, and two were associated with high dosimetric severity. Multi-incident analysis identified five high-risk activities or clinical scenarios as follows: (1) uncommon, low-volume or newly implemented brachytherapy procedures, (2) real-time MR-guided brachytherapy or biopsy procedures, (3) use of in-house devices or software, (4) manual data entry, and (5) patient scheduling and handoffs. CONCLUSIONS: Brachytherapy is a safe treatment and associated with a low rate of patient safety events. Effective incident management is a key element of continuous quality improvement and patient safety in brachytherapy.
Assuntos
Braquiterapia/efeitos adversos , Near Miss/estatística & dados numéricos , Segurança do Paciente , Avaliação de Processos em Cuidados de Saúde , Próstata/patologia , Centros Médicos Acadêmicos/estatística & dados numéricos , Braquiterapia/métodos , Braquiterapia/normas , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Imageamento por Ressonância Magnética , Masculino , Próstata/diagnóstico por imagem , Melhoria de Qualidade , Dosagem Radioterapêutica , Gestão de RiscosRESUMO
BACKGROUND: Because of the increasing importance of computer-assisted post processing of image data in modern medical diagnostic we studied the value of an algorithm for assessment of single photon emission computed tomography/computed tomography (SPECT/CT)-data, which has been used for the first time for lymph node staging in penile cancer with non-palpable inguinal lymph nodes. In the guidelines of the relevant international expert societies, sentinel lymph node-biopsy (SLNB) is recommended as a diagnostic method of choice. The aim of this study is to evaluate the value of the afore-mentioned algorithm and in the clinical context the reliability and the associated morbidity of this procedure. METHODS: Between 2008 and 2015, 25 patients with invasive penile cancer and inconspicuous inguinal lymph node status underwent SLNB after application of the radiotracer Tc-99m labelled nanocolloid. We recorded in a prospective approach the reliability and the complication rate of the procedure. In addition, we evaluated the results of an algorithm for SPECT/CT-data assessment of these patients. RESULTS: SLNB was carried out in 44 groins of 25 patients. In three patients, inguinal lymph node metastases were detected via SLNB. In one patient, bilateral lymph node recurrence of the groins occurred after negative SLNB. There was a false-negative rate of 4 % in relation to the number of patients (1/25), resp. 4.5 % in relation to the number of groins (2/44). Morbidity was 4 % in relation to the number of patients (1/25), resp. 2.3 % in relation to the number of groins (1/44). The results of computer-assisted assessment of SPECT/CT data for sentinel lymph node (SLN)-diagnostics demonstrated high sensitivity of 88.8 % and specificity of 86.7 %. CONCLUSIONS: SLNB is a very reliable method, associated with low morbidity. Computer-assisted assessment of SPECT/CT data of the SLN-diagnostics shows high sensitivity and specificity. While it cannot replace the assessment by medical experts, it can still provide substantial supplement and assistance.
Assuntos
Biópsia Guiada por Imagem/efeitos adversos , Imagem Multimodal , Neoplasias Penianas/diagnóstico por imagem , Biópsia de Linfonodo Sentinela/efeitos adversos , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Adulto , Idoso , Humanos , Biópsia Guiada por Imagem/métodos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Penianas/patologia , Reprodutibilidade dos Testes , Biópsia de Linfonodo Sentinela/métodosRESUMO
PURPOSE: The purpose of the study was to describe and present outcomes of the track embolization technique with absorbable hemostat gelatin powder during percutaneous computed tomography (CT)-guided lung biopsy and/or fiducial marker placement versus the standard of care (no track embolization) in an attempt to decrease rates of pneumothorax (PTX), chest tube placement, hemorrhage and/or complications, and average cost per patient. MATERIALS AND METHODS: An institutional review board-approved, case-control, retrospective study was performed in which 125 consecutive patients who underwent track embolization were compared with 124 consecutive controls at one institution. For subjects in whom the track embolization technique was utilized, it was performed passively through a coaxial needle as it was removed. All procedures were performed by one of three attending interventional radiologists. For each group, medical records and procedure images were reviewed for PTX occurring postprocedure, PTX requiring chest tube placement, and occurrence of minor or major complication and/or hemorrhage. Comparison was made with published complication rates, and a cost-per-patient analysis was performed. Statistical analysis was performed utilizing Fisher's Exact Test. RESULTS: In track embolization cases versus controls, there were statistically significant reduction in PTX (8.8% vs. 21%; P=.007) and reduction in PTX requiring chest tube placement (4% vs. 8.1%; P=.195). This compares favorably to previously published rates of PTX and chest tube placement of 8%-64% and 1.6%-17%, respectively. None of the pneumothoraces occurring at time of needle placement increased in size with use of the track embolization technique. There were no major complications (including neurological sequela) in the track embolization group. In track embolization cases versus controls, there was a statistically significant reduction in both the rate of major hemorrhage (0% vs. 4%; P=.029) and average cost per patient ($262.40 vs. $352.07; P=.044). CONCLUSIONS: CT-guided percutaneous lung biopsy and/or fiducial marker placement were safer utilizing the track embolization technique during trocar removal. In addition, this technique was cost effective in the study population.
Assuntos
Biópsia por Agulha/métodos , Embolização Terapêutica/métodos , Marcadores Fiduciais , Hemotórax/prevenção & controle , Biópsia Guiada por Imagem/métodos , Pulmão/patologia , Pneumotórax/prevenção & controle , Adolescente , Adulto , Idoso , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/economia , Estudos de Casos e Controles , Análise Custo-Benefício , Embolização Terapêutica/economia , Feminino , Seguimentos , Hemotórax/economia , Hemotórax/epidemiologia , Hemotórax/etiologia , Custos Hospitalares , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/economia , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , New York , Segurança do Paciente , Pneumotórax/economia , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/economia , Resultado do TratamentoRESUMO
Image-guided percutaneous liver biopsy (PLB) is a diagnostic tool for lesions in the liver. Hemorrhage is the most common complication. We selected patients with a diagnostic claim for cancer who had undergone PLB. There were a total of 26,941 patients who underwent PLB. Hemorrhage risk was 1.43% among patients undergoing PLB. When stratified by setting, odds of hemorrhage were 4.5 times higher when biopsy was performed in an inpatient setting (p < .001). Risk factors associated with hemorrhage included marital status, liver cancer and comorbidity score. The use of PLB has increased over time. Reassuringly, the hemorrhage risk associated with PLB is low.
Assuntos
Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/estatística & dados numéricos , Neoplasias Hepáticas/patologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Hemorragia/epidemiologia , Hemorragia/etiologia , Humanos , Biópsia Guiada por Imagem/economia , Biópsia Guiada por Imagem/métodos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologiaRESUMO
PURPOSE: To assess the complications of CT-guided percutaneous transthoracic needle aspiration and/or core biopsy (PTNAB) of lung nodules in patients with pulmonary arterial hypertension (PHTN). METHOD AND MATERIALS: We analyzed PTNAB of 74 lung lesions (mean size: 3.6 ± 2.1 cm) in 74 patients (M: F 38:36; age 68 ± 15 years) with documented PHTN on cardiac ultrasound. 39 patients with lung lesions (M: F 24:15; age 65 ± 14) who underwent PTNAB in the same period with right ventricle systolic pressure (RVSP) <35 mm Hg were selected as controls. Pulmonary arterial pressures were estimated on cardiac ultrasounds by using the tricuspid regurgitation jet method. Two thoracic radiologists reviewed the medical records and PTNAB images on a PACS station and documented nodule size, location, distance traversed in lung, technical success and complications. RESULTS: Fine needle aspirates were obtained in all and core biopsy in 23% (17/74) of the nodules. 61% (45/74) of the nodules were in the middle and 39% (29/74) were in the outer third of lung. PHTN was mild, moderate and severe in 84% (62/74), 13% (10/74) and 3% (2/74) of the patients. Biopsy was complicated by hemorrhage in 26% (19/74), moderate hemoptysis in 1.3% (1/74), pneumothorax in 17% (12/74), chest tube in 1.3% (1/74) and hemothorax in 1.3% (1/74) of the patients. The complications rate in control group was similar, hemorrhage in 33% (19/39) (p=0.6), moderate hemoptysis in 5% (2/39) (p=0.3), pneumothorax in 28% (11/39) (p=0.2), chest tube in (0/39) (p=0.3), and hemothorax in 3% (1/39) of the patients (p=0.7). CONCLUSION: Percutaneous needle biopsy of lung lesions in patients with mild to moderate PHTN can be performed without significant increase in complications.
Assuntos
Hipertensão Pulmonar/complicações , Neoplasias Pulmonares/diagnóstico , Pulmão/diagnóstico por imagem , Pulmão/patologia , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X/mortalidade , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina/efeitos adversos , Biópsia com Agulha de Grande Calibre/efeitos adversos , Feminino , Hemoptise/etiologia , Hemorragia/etiologia , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Pneumotórax/etiologia , Estudos RetrospectivosRESUMO
OBJECTIVES: To quantify the degree of pain experienced by patients who undergo ultrasound-guided transrectal prostate biopsy in standard clinical practice and assess the clinical factors associated with increased pain. MATERIAL AND METHODS: Analysis of a multicenter series of patients with prostate biopsy according to standard clinical practice. The biopsy was performed transrectally with a protocol of local anesthesia on the posterolateral nerve bundle. The pain was assessed at 20minutes into the procedure using the visual analog scale (0-10). The degree of pain was analyzed, and the association was studied using a univariate/multivariate analysis of selected clinical variables and the degree of pain. RESULTS: A total of 1188 patients with a median age of 64 years were analyzed. Thirty percent of the biopsies were diagnosed with a tumor. The median pain score was 2, with 65% of the patients reporting a pain score ≤2. The multivariate analysis showed that the prostate volume (RR, 1.34; 95% CI 1.01-1.77; P=.04), having a previous biopsy (RR, 2.25; 95% CI 1.44-3.52; P<.01), age (RR, .63; 95% CI .47-.85; P<.01) and feel palpation (RR, 1.95; 95% CI 1.28-2.96; P<.01) were factors independently associated with greater pain during the procedure. CONCLUSIONS: Transrectal biopsy with local anesthesia is a relatively painless technique. Factors such as age, a previous biopsy, pain on being touched and prostate volume were associated with the presence of greater pain during the procedure.
Assuntos
Anestesia Local , Medição da Dor , Dor/etiologia , Próstata/patologia , Neoplasias da Próstata/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodos , Masculino , Pessoa de Meia-Idade , Próstata/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Reto , Estudos Retrospectivos , Ultrassonografia de Intervenção , Procedimentos Cirúrgicos Urológicos/efeitos adversosRESUMO
PURPOSE: Image-guided transthoracic needle biopsy (IGTTNB) is an important tool in the diagnosis of patients with cancer. Common complications include pneumothorax and chest tube placement, with rates ranging from 6% to 57%. We performed a population-based study to determine patterns of use, complications, and costs associated with IGTTNB. METHODS: The Premier Perspective database was used to identify patients with cancer with ≥ one claim for IGTTNB from 2006 to 2012. Patients were stratified on the basis of inpatient versus outpatient setting. Pneumothorax was defined by a new claim within 1 month of IGTTNB; hospitalization and chest tube placement rates were analyzed. Multivariable analysis was used to identify factors associated with pneumothorax. RESULTS: We Identified 79,518 patients with cancer who underwent IGTTNB: 42,955 (54.0%) outpatients and 36,563 (46.0%) inpatients. Of patients who underwent outpatient IGTTNB, 5,261 (12.2%) developed a pneumothorax. Of those, 1,006 (19.1%, 2.3% of total) were hospitalized, and 180 (3.4%, 0.42% of total) required chest tubes. Pneumothorax after outpatient IGTTNB was associated with number of comorbidities, rural site, hospital bed size of more than 600, and biopsy of parenchymal as opposed to pleural lesions. Of patients who underwent inpatient IGTTNB, 7,830 (21.4%) developed a pneumothorax, and 2,894 (36.0%, 7.9% of total) required chest tube. Over time, total IGTTNB volume increased by 40.6%, and mean outpatient cost per procedure increased by 24.4%. CONCLUSION: While pneumothorax was frequent in outpatients, rates of hospitalization and chest tube placement were low. As screening for lung cancer increases, we anticipate an increased need for IGTNBB. Patients can be reassured by the low rate of serious complications.
Assuntos
Assistência Ambulatorial/tendências , Biópsia por Agulha/tendências , Hospitalização/tendências , Biópsia Guiada por Imagem/tendências , Neoplasias Pulmonares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/economia , Biópsia por Agulha/estatística & dados numéricos , Tubos Torácicos , Distribuição de Qui-Quadrado , Bases de Dados Factuais , Feminino , Custos de Cuidados de Saúde , Hospitalização/economia , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/economia , Biópsia Guiada por Imagem/estatística & dados numéricos , Modelos Logísticos , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Pneumotórax/etiologia , Pneumotórax/terapia , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: Assessment of patients with suspected interstitial lung disease (ILD) includes surgical lung biopsy (SLB) when clinical and radiological data are inconclusive. However, cryobiopsy is acquiring an important role in the ILD diagnostic process. The objective of this study was to evaluate the diagnostic yield, safety and economic costs of the systematic use of cryobiopsy in the assessment of patients with suspected ILD. METHODS: This was a retrospective observational study of patients who had undergone transbronchial cryobiopsy for evaluation of ILD from January 2011 to January 2014. The procedures were performed with a video bronchoscope using a cryoprobe for the collection of lung parenchyma specimens, which were analyzed by pathologists. Diagnostic yield, complications and economic costs of this technique were analyzed. RESULTS: Criobiopsy specimens from a total of 33 patients were included. A specific diagnosis was obtained in 26, producing a diagnostic yield of 79%. In 5 patients, SLB was required for a histopathological confirmation of disease, but the procedure could not be performed in 4, due to severe comorbidities. The most frequent complications were pneumothorax (12%) and gradei (9%) or gradeii (21%) bleeding. There were no life-threatening complications. The systematic use of cryobiopsy saved up to 59,846. CONCLUSION: Cryobiopsy is a safe and potentially useful technique in the diagnostic assessment of patients with ILD. Furthermore, the systematic use of cryobiopsy has an important economic impact.