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Einstein (Säo Paulo) ; 20: eAO6665, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1375331


ABSTRACT Objective To describe an experience in the preoperative localization of small pulmonary nodules and ground-glass lesions to guide minimally invasive thoracic surgery; in addition, a literature review was conducted, including the main advantages and disadvantages of the different agents used, and site marking in a hybrid operating room. Methods A retrospective search was conducted in a Interventional Radiology Department database, between March 2015 and May 2019, to identify patients undergoing preoperative percutaneous marking of lung injuries measuring up to 25mm. Results A total of 20 patients were included and submitted to descriptive analysis. All patients were marked in a hybrid room, at the same surgical-anesthetic time. Most often used markers were guidewire, Lipiodol® and microcoils. Despite one case of coil displacement, two cases of pneumothorax, and one case of hypotension after marking, all lesions were identified and resected accordingly from all patients. Conclusion Preoperative percutaneous localization of lung injuries in hybrid room is an effective and a safe technique, which can have decisive impact on surgical resection. The choice of marker and of the operating room scenario should be based on availability and experience of service. Multidisciplinary discussions with surgical teams, pathologists, and interventional radiologists are crucial to improve outcome of patients.

J. bras. pneumol ; 44(4): 307-314, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-975920


ABSTRACT Objective: To evaluate the diagnostic accuracy of CT-guided percutaneous core needle biopsy (CT-CNB) of pulmonary nodules ≤ 2 cm, as well as to identify factors influencing the accuracy of the procedure and its morbidity. Methods: This was a retrospective, single-center study of 170 consecutive patients undergoing CT-CNB of small pulmonary nodules (of ≤ 2 cm) between January of 2010 and August of 2015. Results: A total of 156 CT-CNBs yielded a definitive diagnosis, the overall diagnostic accuracy being 92.3%. Larger lesions were associated with a higher overall accuracy (OR = 1.30; p = 0.007). Parenchymal hemorrhage occurring during the procedure led to lower accuracy rates (OR = 0.13; p = 0.022). Pneumothorax was the most common complication. A pleura-to-lesion distance > 3 cm was identified as a risk factor for pneumothorax (OR = 16.94), whereas performing a blood patch after biopsy was a protective factor for pneumothorax (OR = 0.18). Conclusions: Small nodules (of < 2 cm) represent a technical challenge for diagnosis. CT-CNB is an excellent diagnostic tool, its accuracy being high.

RESUMO Objetivo: Avaliar a precisão diagnóstica da biópsia percutânea com agulha grossa, guiada por TC - doravante denominada BAG-TC - de nódulos pulmonares ≤ 2 cm, bem como identificar fatores que influenciam a precisão do procedimento e sua morbidade. Métodos: Estudo retrospectivo, realizado em um único centro, com 170 pacientes consecutivos submetidos a BAG-TC de nódulos pulmonares pequenos (≤ 2 cm) entre janeiro de 2010 e agosto de 2015. Resultados: Do total de biópsias, 156 resultaram em diagnóstico definitivo, com precisão diagnóstica global de 92,3%. Lesões maiores estiveram relacionadas com maior precisão global (OR = 1,30; p = 0,007). A presença de hemorragia parenquimatosa durante o procedimento resultou em menor precisão (OR = 0,13; p = 0,022). Pneumotórax foi a complicação mais comum. Uma distância > 3 cm entre a lesão e a pleura foi identificada como fator de risco de pneumotórax (OR = 16,94), ao passo que a realização de tampão sanguíneo após a biópsia foi um fator de proteção contra o pneumotórax (OR = 0,18). Conclusões: O diagnóstico de nódulos pequenos (< 2 cm) é um desafio do ponto de vista técnico. A BAG-TC é uma excelente ferramenta diagnóstica, cuja precisão é alta.

Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pneumothorax/etiology , Multiple Pulmonary Nodules/pathology , Biopsy, Large-Core Needle/methods , Image-Guided Biopsy/methods , Lung Neoplasms/pathology , Tomography, X-Ray Computed , Retrospective Studies , Risk Factors , Solitary Pulmonary Nodule/pathology , Biopsy, Large-Core Needle/adverse effects , Image-Guided Biopsy/adverse effects , Hemorrhage/etiology
Int. braz. j. urol ; 44(1): 192-195, Jan.-Feb. 2018. graf
Article in English | LILACS | ID: biblio-892936


ABSTRACT The biochemical recurrence after local treatment for prostate cancer is an often challenging condition of clinical management. The aim of this report is to demonstrate the importance of the association of various imaging methods in the identification and subsequent accurate percutaneous biopsy in patients with recurrence of prostate cancer, especially in unusual sites. An 86 years old male with biochemical recurrence, during radiological investigation a PET-MRI was noted the presence of an asymmetry of the vas deferens with PSMA-68Ga uptaken, suggesting the recurrence. A percutaneous fusion biopsy with PET-MRI and ultrasound was performed using transrectal access using ultrasound confirming infiltrating adenocarcinoma of the wall of the vas deferens, compatible with neoplastic prostate recurrence. The fusion image technique combines the real-time view of the US to the possibility of higher definition and higher specificity, methods more anatomical detail as tomography and magnetic resonance imaging, simultaneously. High resolution acquired in PET / MR associated with image fusion allows orientation procedures, even in areas of difficult access, with greater accuracy than conventional techniques.

Humans , Male , Aged , Prostatic Neoplasms/diagnostic imaging , Adenocarcinoma/diagnostic imaging , Ultrasonography, Interventional/methods , Image-Guided Biopsy/methods , Neoplasm Recurrence, Local/diagnostic imaging , Prostatectomy , Prostatic Neoplasms/surgery , Prostatic Neoplasms/pathology , Magnetic Resonance Imaging , Adenocarcinoma/surgery , Adenocarcinoma/pathology , Tomography, X-Ray Computed , Ultrasonography , Neoplasm Recurrence, Local/surgery , Neoplasm Recurrence, Local/pathology
Einstein (Säo Paulo) ; 7(2): 137-140, 2009. ilus
Article in English | LILACS-Express | LILACS | ID: lil-520365


Objective: To report the experience with percutaneous biopsies of pancreatic grafts guided by ultrasonography. Methods: Series of cases referred from outpatient's clinic for biopsy of pancreas transplant, between December 2006 and March 2008. Data were collected from medical electronic records for age, sex and histopathology. The indication for the procedure was obtained from medical and laboratory records. Doppler ultrasonography was performed for control and to guide biopsy in real time. Results: Twenty patients referred for biopsy of their transplanted pancreas over a one-year period were evaluated. In one patient, biopsy was not performed for having no safe access for ultrasound. It was used 18 gauge needles, mostly automatic-cut type. The main indications were increased blood glucose and pancreatic enzyme levels as well as reduction of urinary amylase. The sonographic aspect of the pancreatic graft was normal in 18 cases. In all 19 biopsies performed, satisfactory samples for histopathological study were obtained. There were no complications. Conclusions: This series of cases demonstrated low sensitivity and specificity of ultrasound in diagnosis of pancreatic transplants disorders, but showed to be very useful to guide transplanted pancreas biopsies. Although no complications occurred in this experience, the risk-benefit relation should always be assessed for every patient.

Objetivo: Relatar experiência com biópsias percutâneas de enxerto pancreático guiadas por ultrassonografia. Métodos: Série de casos encaminhados ambulatorialmente para biópsia de pâncreas transplantado no período de dezembro de 2006 a março de 2008. Dados referentes à idade, sexo e resultados histopatológicos foram colhidos a partir dos registros de prontuários eletrônicos. A indicação do procedimento foi obtida a partir dos pedidos médicos bem como de registros laboratoriais. A ultrassonografia com Doppler foi realizada para controle antes e após o procedimento e para guiar a punção em tempo real. Resultados: Vinte pacientes encaminhados para biópsia de pâncreas transplantado no período de um ano foram avaliados. Em um paciente, a biópsia não foi realizada por falta de uma via de acesso segura por ultrassom. O aspecto ultrassonográfico do órgão transplantado foi normal em 18 casos. Em todas as 19 biópsias executadas, foram obtidas amostras satisfatórias para o estudo histopatológico e não houve complicações. Conclusões: Esta série de casos reforça as baixas sensibilidade e especificidade da ultrassonografia no diagnóstico de disfunções de enxertos pancreáticos, porém mostra sua grande utilidade no auxílio de biópsias do órgão transplantado. Apesar de não terem ocorrido complicações nesta experiência, o procedimento deve sempre ser avaliado quanto ao risco-benefício para todos os pacientes.

Einstein (Säo Paulo) ; 6(4): 428-433, 2008.
Article in Portuguese | LILACS | ID: lil-510106


Objetivos: Avaliar a taxa de sucesso de injeção percutânea detrombina, guiada por ultra-som com Doppler para o tratamento de pseudo-aneurismas femorais. Métodos: Vinte e três pacientes compseudo-aneurismas femorais foram tratados com injeção percutâneade trombina guiada por ultra-som com Doppler, entre Setembro de2003 e Outubro de 2007. O tamanho do pseudo-aneurisma, a dosede trombina utilizada, o resultado da terapia e as complicações foramdocumentados prospectivamente. Outros aspectos analisados foramo tipo de procedimento que causou o pseudo-aneurisma (cateterismodiagnóstico, angioplastia, colocação do stent), o tamanho dointrodutor endovascular, a utilização dos dispositivos hemostáticos eo índice de massa corpórea (IMC) do paciente. Resultados: Um totalde 27 injeções de trombina foram realizadas. O diâmetro transversomédio foi de 3,5 cm. A dose média de trombina injetada foi de 666,7UI. A taxa primária de sucesso foi de 19 em 23 pacientes (83%).A reperfusão ocorreu em um pseudo-aneurisma. A taxa de sucessosecundária foi de quatro em quatro pacientes tratados (100%). Nãoocorreram complicações tromboembólicas, infecciosas ou alérgicas. Conclusões: A injeção percutânea de trombina guiada por ultra-som é o melhor método para o tratamento dos pseudo-aneurismas femorais causados por procedimentos endovasculares. Apresenta elevadastaxas de sucesso, baixas taxas de reincidência e de complicações.

Aneurysm, False/diagnosis , Aneurysm, False/therapy , Thrombin , Treatment Outcome , Ultrasonography, Doppler