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1.
Medicine (Baltimore) ; 100(3): e24001, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545994

RESUMO

ABSTRACT: We aim to compare the diagnostic accuracy, safety, and radiation exposure between low-dose and standard-dose computed tomography (CT)-guided cutting needle biopsy (CNB) for lung nodules.From January 2016 to August 2017, all consecutive patients admitted with lung nodule underwent low-dose or standard-dose CT-guided CNB procedure in our center. Diagnostic accuracy and radiation dose were compared.A total of 67 and 69 patients who underwent low-dose and standard-dose CT-guided CNB procedure were included in this study. Each patient underwent CT-guided CNB for 1 nodule. The technical success rates were 100% in both groups. The sensitivity, specificity, and overall diagnostic accuracy were 97.7%, 100%, and 98.5% for low-dose group and 91.5%, 100%, and 94.2% for standard-dose group. There was no significant difference in diagnostic accuracy (P = .380) between 2 groups. Pneumothorax was found in 8 and 15 patients in the low-dose and standard-dose groups, respectively (11.9% vs 21.7%, P = .127). Hemoptysis was found in 10 and 10 patients in the low-dose and standard-dose groups, respectively (14.9% vs 14.5%, P = .943). The mean dose-length product was 38.2 ±â€Š17.2 mGy-cm and 375.3 ±â€Š115.7 mGy-cm in the low-dose and standard-dose groups (P < .001). The mean dose-length product was 38.2 ±â€Š17.2 mGy-cm and 375.3 ±â€Š115.7 mGy-cm in the low-dose and standard-dose groups, respectively (P < .001). The mean effective dose was 0.5 ±â€Š0.2 mSv and 5.3 ±â€Š1.6 mSv in the low-dose and standard-dose groups, respectively (P < .001).Low-dose CT-guided CNB of lung nodules significantly decreased radiation dose compared with standard-dose CT. The low-dose protocol could provide similar diagnostic accuracy and safety as standard-dose CT-guided CNB for lung nodules.


Assuntos
Biópsia por Agulha/métodos , Detecção Precoce de Câncer/métodos , Biópsia Guiada por Imagem/métodos , Neoplasias Pulmonares/diagnóstico , Doses de Radiação , Tomografia Computadorizada por Raios X , Idoso , Biópsia por Agulha/efeitos adversos , Feminino , Hemoptise/etiologia , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Pneumotórax/etiologia , Exposição à Radiação/efeitos adversos , Exposição à Radiação/análise , Lesões por Radiação/etiologia , Estudos Retrospectivos , Sensibilidade e Especificidade
2.
Isr Med Assoc J ; 22(12): 765-769, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33381949

RESUMO

BACKGROUND: Lung percutaneous needle biopsy (PNB) is routinely used to diagnose lung cancer. The most prevalent complications of PNB are pneumothorax and bleeding. Differences in characteristics of medical procedures between rural and urban hospitals are well known. OBJECTIVES: To compare characteristics of patients and lesions between two hospitals and to evaluate whether lung PNB complications differ in rural vs. urban settings. METHODS: The authors examined case records of 561 patients who underwent lung biopsy at two different medical centers in Israel: Tel Aviv Sourasky Medical Center (urban) and Barzilai Medical Center (rural). To evaluate the complication rates, the authors analyzed findings from chest X-ray performed 2 hours after biopsy and computed tomography (CT) images at the site of biopsy. RESULTS: The study comprised 180 patients who underwent lung biopsy at Barzilai and 454 at Sourasky. The rate of pneumothorax did not differ between centers (12% at Barzilai and 19% at Sourasky, P = 0.08). Distance from pleura was positively correlated to pneumothorax occurrence in both centers; however, neither lesion size nor lesion locus was found to be a risk factor for pneumothorax. Mild bleeding at the biopsy site occurred equally at Barzilai and Sourasky (32% vs. 36%, P = 0.3, respectively). Furthermore, immediate CT post-biopsy at Barzilai showed 95% negative predictive value, showing that a CT scan performed immediately after lung biopsy cannot replace the routine follow-up chest X-ray in predicting iatrogenic pneumothorax. CONCLUSIONS: CT-guided percutaneous lung biopsies are comparable between rural and urban hospitals regarding procedure characteristics and complication rates.


Assuntos
Biópsia por Agulha/métodos , Hospitais Rurais , Pulmão/patologia , Radiografia Intervencionista , Biópsia por Agulha/efeitos adversos , Hemorragia/etiologia , Hospitais Urbanos , Humanos , Israel , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Pneumotórax/etiologia , Radiografia Intervencionista/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
3.
Anticancer Res ; 40(11): 6437-6441, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109582

RESUMO

BACKGROUND/AIM: Magnetic resonance imaging (MRI)-guided breast biopsy is a complex and time-consuming procedure. This study aimed to clarify the factors that affect the duration of the procedure. PATIENTS AND METHODS: Twenty-eight examinations performed at our institute for 27 lesions detected solely on MRI were analyzed. The correlations between the clinicopathological factors and duration of the procedure were estimated. RESULTS: The needle guidance method was the only factor that significantly affected the duration of the MRI-guided vacuum-assisted breast biopsy (VAB) (p=0.012). The use of a computer-aided detection (CAD) system with grid breast compression plates had significantly shorter durations (62±12 min) than the manual calculation of coordinates with pillar-type compression plates (76±13 min). CONCLUSION: This preliminary study showed that the use of a CAD system might shorten the duration of MRI-guided VAB.


Assuntos
Neoplasias da Mama/diagnóstico , Mama/diagnóstico por imagem , Biópsia Guiada por Imagem , Imagem por Ressonância Magnética Intervencionista , Adulto , Idoso , Biópsia por Agulha/métodos , Mama/patologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Tempo , Vácuo
5.
Niger J Clin Pract ; 23(9): 1183-1187, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913154

RESUMO

Aims: This study compared the analgesic effect of apical peri-prostatic block with that of intra-rectal xylocaine gel for trans-rectal ultrasound guided prostate biopsy (TRUS-PBx) in Nigeria. Methods: This is a prospective randomized comparative study carried out over one year in University of Benin Teaching Hospital, Edo State, Nigeria. The participants were randomized into two groups; Group A had 10 mls of intra-rectal xylocaine gel instillation while Group B had apical infiltration of 10 mls of 1% xylocaine all before TRUS-PBx. Result: There was a statistically significant difference in the mean pain score during and one hour after TRUS-PBx between Group A and Group B of the study population respectively (p < 0.0001). Those that had intra-rectal xylocaine gel (Group A) had more pain during and after biopsy. There was no difference in the mean pain score during probe insertion between the two groups (p = 0.952). Conclusion: This study demonstrated the superiority of apical peri-prostatic nerve block over intra rectal xylocaine gel instillation during TRUS-PBx with respect to its anesthetic efficacy. Therefore, centers providing TRUS-PBx in Nigeria should consider apical peri-prostatic nerve block as their mode of anesthesia for the procedure due to its efficacy and high safety profile.


Assuntos
Biópsia por Agulha/métodos , Biópsia Guiada por Imagem/métodos , Lidocaína/administração & dosagem , Bloqueio Nervoso/métodos , Dor/prevenção & controle , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Administração Retal , Idoso , Anestésicos Locais/administração & dosagem , Biópsia por Agulha/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Dor/etiologia , Medição da Dor , Estudos Prospectivos , Próstata/diagnóstico por imagem , Próstata/inervação , Reto/patologia , Ultrassonografia de Intervenção
6.
PLoS One ; 15(8): e0238107, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32834016

RESUMO

BACKGROUND: In CT-guided transthoracic lung biopsy (CTLB), pneumothorax can occur as a late complication (delayed pneumothorax). The incidence, risk factors, and clinical significance of delayed pneumothorax are not well known. OBJECTIVES: To compare the risk factors for immediate and delayed pneumothorax after CTLB and to know their clinical significance. METHODS: Images and medical records of 536 consecutive patients who underwent CTLB were reviewed. All biopsies were performed as inpatient procedures. Follow-up chest radiographs were obtained at least twice at 4 h after procedure and before discharge. Risk factors for immediate and delayed pneumothorax were assessed based on patient-, lesion-, and procedure-related variables. Rates of chest tube insertion were also compared. RESULTS: Pneumothorax developed in 161 patients (30.0%) including 135 (25.2%) immediate and 26 (4.9%) delayed cases. Lesion size was an independent risk factor for both immediate and delayed pneumothorax (OR = 0.813; CI = 0.717-0.922 and OR = 0.610; CI = 0.441-0.844, respectively). While emphysema, lower lobe location, and long intrapulmonary biopsy track were risk factors (OR = 1.981; CI = 1.172-3.344, OR = 3.505; CI = 2.718-5.650, and OR = 1.330; CI = 1.132-1.563, respectively) for immediate pneumothorax, upper lobe location and increased number of pleural punctures were independent risk factors (OR = 5.756; CI = 1.634-20.274 and OR = 3.738; CI = 1.860-7.511, respectively) for delayed pneumothorax. The rate of chest tube insertion was significantly (p < 0.001) higher in delayed pneumothorax. CONCLUSION: Pneumothorax tends to occur immediately after CTLB in patients with emphysema, lower lobe lesion, and long intrapulmonary biopsy track. Further attention and warnings are needed for those with multiple punctures of small lesions involving upper lobes due to the possibility of delayed development of pneumothorax and higher requirement for chest tube drainage.


Assuntos
Biópsia Guiada por Imagem/efeitos adversos , Pneumotórax/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/métodos , Tubos Torácicos , Enfisema/patologia , Feminino , Humanos , Incidência , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Paracentese/efeitos adversos , Enfisema Pulmonar/patologia , Punções/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Tórax , Tomografia Computadorizada por Raios X/efeitos adversos , Tomografia Computadorizada por Raios X/métodos
7.
Medicine (Baltimore) ; 99(27): e21076, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629740

RESUMO

BACKGROUND AND OBJECTIVE: Undiagnosed pleural effusions (UPEs) are a common problem of respiratory medicine, leading to an increased diagnostic burden globally. However, the most efficient and cost-effective approaches to UPEs remain controversial. This study aimed to assess the diagnostic value of ultrasound-guided needle biopsy (UGNB) in UPEs. METHODS: We conducted a search of PubMed, Embase, the Cochrane Library and reference lists of retrieved studies with no publication data limitation. Articles that investigated the diagnostic accuracy of UGNB in UPEs were included. The quality of eligible studies was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. The diagnostic value of UGNB was evaluated by calculating the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds rate, and the area under the curve for the summary receiver operating characteristic curve using a random effects model. RESULTS: Seven studies comprising 165 patients with UPEs met the inclusion criteria. UGNB had a pooled sensitivity of 83% (95% confidence intervals [CI], 75% - 89%), a specificity of 100% (95% CI, 90% - 100%), a positive likelihood ratio of 8.89 (95% CI, 3.29 - 24.02), a negative likelihood ratio of 0.23 (95% CI, 0.16 - 0.33), a diagnostic odds rate of 51.47 (95% CI, 14.70 - 180.16), and an area under the curve of 0.94. Six pneumothorax cases (3.6%), 5 local wound infections (3.0%), and 1 empyema case (less than 1%) were observed. There was no significant heterogeneity or publication bias in this study. CONCLUSIONS: Based on current evidence, UGNB is a safe and convenient procedure with a high accuracy for diagnosing UPEs. However, physicians should still be cautious in interpreting negative UGNB results.


Assuntos
Biópsia Guiada por Imagem/instrumentação , Derrame Pleural/patologia , Ultrassonografia de Intervenção/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/métodos , Empiema/epidemiologia , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico por imagem , Pneumotórax/epidemiologia , Sensibilidade e Especificidade , Ultrassonografia de Intervenção/efeitos adversos , Infecção dos Ferimentos/epidemiologia , Adulto Jovem
10.
PLoS One ; 15(7): e0236295, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32706813

RESUMO

The purpose of the present study was to integrate an interactive gradient-based needle navigation system and to evaluate the feasibility and accuracy of the system for real-time MR guided needle puncture in a multi-ring phantom and in vivo in a porcine model. The gradient-based navigation system was implemented in a 1.5T MRI. An interactive multi-slice real-time sequence was modified to provide the excitation gradients used by two sets of three orthogonal pick-up coils integrated into a needle holder. Position and orientation of the needle holder were determined and the trajectory was superimposed on pre-acquired MR images. A gel phantom with embedded ring targets was used to evaluate accuracy using 3D distance from needle tip to target. Six punctures were performed in animals to evaluate feasibility, time, overall error (target to needle tip) and system error (needle tip to the guidance needle trajectory) in vivo. In the phantom experiments, the overall error was 6.2±2.9 mm (mean±SD) and 4.4±1.3 mm, respectively. In the porcine model, the setup time ranged from 176 to 204 seconds, the average needle insertion time was 96.3±40.5 seconds (min: 42 seconds; max: 154 seconds). The overall error and the system error was 8.8±7.8 mm (min: 0.8 mm; max: 20.0 mm) and 3.3±1.4 mm (min: 1.8 mm; max: 5.2 mm), respectively.


Assuntos
Biópsia por Agulha , Biópsia Guiada por Imagem , Imagem por Ressonância Magnética , Punções , Animais , Biópsia por Agulha/instrumentação , Biópsia por Agulha/métodos , Biópsia Guiada por Imagem/instrumentação , Biópsia Guiada por Imagem/métodos , Imagem por Ressonância Magnética/instrumentação , Imagem por Ressonância Magnética/métodos , Agulhas , Imagens de Fantasmas , Punções/instrumentação , Punções/métodos , Suínos
11.
Sci Rep ; 10(1): 12248, 2020 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32699296

RESUMO

This study investigates mosquito proboscis-inspired (MPI) insertion applied to the clinically used biopsy needle to reduce tissue deformation and organ displacement. Advanced medical imagining has enabled early-stage identification of cancerous lesions that require needle biopsy for minimally invasive tissue sampling and pathological analysis. Accurate cancer diagnosis depends on the accuracy of needle deployment to the targeted cancerous lesion site. However, currently available needle delivery systems deform and move soft tissue and organs, leading to a non-diagnostic biopsy or undersampling of the target. Two features inspired by the mosquito proboscis were adopted for MPI insertion in prostate biopsy: (1) the harpoon-shape notches at the needle tip and (2) reciprocating needle-cannula motions for incremental insertion. The local tissue deformation and global prostate displacement during the MPI vs. traditional direct insertions were quantified by optically tracking the displacement of particle-embedded tissue-mimicking phantoms. Results show that the MPI needle insertion reduced both local tissue deformation and global prostate displacement because of the opposite needle-cannula motions and notches which stabilized and reduced the tissue deformation during insertion. Findings provide proof of concept for MPI insertion in the clinical biopsy procedures as well as insights of needle-tissue interaction for future biopsy technology development.


Assuntos
Biópsia por Agulha/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Humanos , Masculino , Movimento (Física) , Agulhas , Imagens de Fantasmas , Próstata/patologia
12.
Medicine (Baltimore) ; 99(26): e20822, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590768

RESUMO

INTRODUCTION: Extranodal natural killer/T-cell lymphoma (ENKTL) - nasal type is an aggressive form of malignant non-Hodgkin lymphoma with a very poor prognosis. Especially primary pulmonary ENKTL is a relatively rare form of non-Hodgkin lymphoma. Until now, the prevalence of primary pulmonary ENKTL is unknown. Since 2001, only 18 cases of primary pulmonary ENKTL have been published, in addition to the 2 cases reported here. PATIENT CONCERNS: We describe 2 cases of primary pulmonary ENKTL. Both patients were male non-smokers, aged 61 and 49 years. Their main clinical symptoms included cold-like symptoms and intermittent fever (39.3°C and 38.8°C) for some days (40 days and 3 weeks). Both patients had no relevant personal or family medical history. DIAGNOSIS: The patients were initially misdiagnosed with community-acquired pneumonia. Primary pulmonary ENKTL was confirmed by immunohistochemical staining of computed tomography-guided transthoracic needle biopsy specimens. Both cases were positive for CD56, CD3, and in situ hybridization for Epstein-Barr virus-encoded small RNA, but negative for CD20. INTERVENTIONS: Initially, both patients were treated inadequately with intravenous moxifloxacin administration (unknown dosage and 400 mg q.d) in their local hospitals. Once diagnosed with primary pulmonary ENKTL in our hospital, they received 3 cycles of chemotherapy with combined regimens of dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide (SMILE), and in the second patient, bone marrow transplantation was performed following the third chemotherapy cycle. OUTCOMES: Clinical follow-up after the chemotherapy showed that the condition of the first patient progressively deteriorated. He died 2 months following the initial diagnosis. However, the presence of the hemophagocytic lymphohistocytosis gradually improved in the second patient during chemotherapy. Ultimately, the second patient died of acute transplant rejection 6 months after the initial diagnosis. CONCLUSION: The diagnosis of ENKTL should be considered when patients present with fever and expansile consolidation of the lung not responding to antibiotics. The diagnosis depends on histopathology and immunophenotyping. Percutaneous transthoracic needle biopsy is a safe and effective biopsy method. Chemotherapy may improve the prognosis, but this should be confirmed by prospective multicenter studies.


Assuntos
Linfoma Extranodal de Células T-NK/diagnóstico , Biópsia por Agulha/métodos , Complexo CD3/análise , Complexo CD3/sangue , Antígeno CD56/análise , Antígeno CD56/sangue , Diagnóstico Tardio , Herpesvirus Humano 4/patogenicidade , Humanos , Linfoma Extranodal de Células T-NK/sangue , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
13.
Clin Imaging ; 66: 7-9, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32442858

RESUMO

PURPOSE: The aim of our study is to evaluate the diagnostic performance of CT-guided biopsy of lung nodules ≤10 mm based on their lobar and segmental location. MATERIALS AND METHODS: This was a retrospective study performed on 193 CT-guided percutaneous transthoracic needle biopsies of lung nodules ≤10 mm in greatest dimension, between January 1, 2013 and April 30, 2019. Biopsies were classified as either diagnostic or non-diagnostic based on final cytology and surgical pathology reports. Diagnostic results were those that met parameters for malignancy or a specific benign diagnosis, whereas atypical cells, non-specific benignity, or insufficient specimen were considered non-diagnostic. RESULTS: A total of 1577 CT-guided percutaneous transthoracic needle biopsies were reviewed. Of these, 193 nodules (12.24%) measured ≤10 mm and were selected for further analysis. Of the 193 biopsies, 138 yielded diagnostic results while 56 yielded nondiagnostic results (71% vs 29%, respectively). When analyzed by nodule location, the superior segments of the lower lobes boasted the highest diagnostic yield compared to nodules located in the basal segments of the lower lobes which had the lowest diagnostic yield (84.2% vs 64.7%, respectively). Nodules in the upper lobes and in the middle lobes had a diagnostic yield of 70% and 66.7%, respectively. CONCLUSION: The diagnostic performance of CT-guided biopsy of lung nodules ≤10 mm in diameter may be affected by lobar and segmental location. While the overall performance was good (diagnostic yield of 71%), the yield varied nearly 20% depending on location.


Assuntos
Biópsia Guiada por Imagem/métodos , Lesões Pré-Cancerosas/diagnóstico por imagem , Adulto , Idoso , Biópsia por Agulha/métodos , Feminino , Humanos , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos , Lesões Pré-Cancerosas/patologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
14.
J Bras Pneumol ; 46(2): e20180183, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32402011

RESUMO

OBJECTIVE: To determine the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in non-neoplastic patients with isolated intrathoracic lymphadenopathy (IL). METHODS: This was a retrospective study of patients with isolated IL referred for EBUS-TBNA. We calculated the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of EBUS-TBNA in the diagnosis of granulomatous, reactive, and neoplastic lymphadenopathy. In cases of nonspecific granulomas, reactive lymphadenopathy, or inconclusive results, a definitive diagnosis was established by other diagnostic procedures or during a follow-up period of at least 18 months. RESULTS: Among the 58 patients included in the study, EBUS-TBNA established a diagnosis of granulomatous disease in 22 (38%), reactive lymphadenopathy in 15 (26%), cancer in 8 (14%), and other diseases in 3 (5%). Results were inconclusive in 10 (17%), the diagnosis being established by other bronchoscopic procedures in 2 (20%) and by surgical procedures in 8 (80%). A final diagnosis of reactive lymphadenopathy was established in 12. Of those, 11 (92%) had their diagnosis confirmed during follow-up and 1 (8%) had their diagnosis confirmed by mediastinoscopy. In another 3, a final diagnosis of sarcoidosis or neoplasm was established. For the diagnosis of granulomatous disease, neoplasms, and reactive lymphadenopathy, EBUS-TBNA was found to have a sensitivity of 73%, 68%, and 92%, respectively; a specificity of 100%, 100%, and 93%, respectively; an accuracy of 86%, 93%, and 93%, respectively; a PPV of 100%, 100%, and 80%, respectively; and an NPV of 78%, 92%, and 98%, respectively. CONCLUSIONS: In non-neoplastic patients, granulomatous disease and reactive lymphadenopathy appear to be common causes of isolated IL. EBUS-TBNA shows promising results as a first-line minimally invasive diagnostic procedure. The results obtained by EBUS-TBNA can be optimized by examining clinical and radiological findings during follow-up or by comparison with the results obtained with other bronchoscopic methods.


Assuntos
Brônquios/diagnóstico por imagem , Broncoscopia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Linfonodos/diagnóstico por imagem , Linfadenopatia/diagnóstico por imagem , Mediastino/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Biópsia por Agulha Fina , Biópsia por Agulha/métodos , Brônquios/patologia , Humanos , Linfonodos/patologia , Linfadenopatia/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade
16.
PLoS One ; 15(4): e0231523, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298324

RESUMO

BACKGROUND: Ultrasound-guided transthoracic core needle biopsy (US-TCNB) is a promising method for establishing the correct diagnosis of mediastinal masses. However, the existing studies in this area are scant and with small samples. PURPOSE: To evaluate the diagnostic value and the complication rate of US-TCNB, particularly large bore cutting biopsy in patients with mediastinal lesions. MATERIAL AND METHODS: This retrospective study includes 566 patients with mediastinal lesions suspicious of malignancy evaluated between March 2004 and December 2018. Inclusion criteria: 1. Patients with mediastinal lesions detected on thoracic CT scan; 2. Lesions more than 15 mm; 3. Negative histological diagnosis after bronchoscopic biopsy; 4. Normal coagulation status; 5. Cooperative patient; 6. Written informed consent. US visualization of the mediastinal lesions was successful in 308 (54.4%). In all of them, US-TCNB was performed. All patients with mediastinal lesions unsuitable for US visualization were evaluated for a CT-guided transthoracic needle biopsy (CT-TTNB), which was done if the presence of a safe trajectory was available (n = 41, 7.2%). All patients inappropriate for image-guided TTNB were referred to primary surgical diagnostic procedures (n = 217, 38.3%). RESULTS: The US-TCNB is a highly effective (accuracy 96%, sensitivity 95%) and safe tool (2.6% complications) in the diagnosis of all subgroups mediastinal lesions. It is non-inferior to CT-TTNB (90%) and comes close to the effectiveness of surgical biopsy techniques (98.4%), but is less invasive and with a lower complication rate. CONCLUSION: US-TCNB of mediastinal lesions is highly effective and safe tool which is particularly helpful in critically ill patients.


Assuntos
Biópsia por Agulha/métodos , Neoplasias do Mediastino/diagnóstico , Mediastino/patologia , Ultrassonografia de Intervenção/métodos , Biópsia por Agulha/efeitos adversos , Feminino , Humanos , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Mediastino/diagnóstico por imagem , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia de Intervenção/efeitos adversos
17.
Zhonghua Yi Xue Za Zhi ; 100(11): 864-867, 2020 Mar 24.
Artigo em Chinês | MEDLINE | ID: mdl-32234160

RESUMO

Objective: To investigate the accuracy and safety of ultrasound-guided puncture biopsy and enhanced MRI in the diagnosis of alpha-fetoprotein (AFP) negative liver occupying lesions. Methods: Retrospective analysis was conducted on the clinical data of 59 patients with liver occupying lesions who were admitted to the Fifth Medical Center of the PLA General Hospital from February 2015 to November 2017 and received ultrasound-guided coarse needle biopsy with AFP negative. Among them, 35 cases were males and 24 cases were females, the age range was from 25 to 67 years,with an average age of (51±3) years. Serum AFP in all patients were within the normal range. The difference between the pathological results of ultrasound-guided biopsy and the diagnosis of lesions by enhanced MRI was compared, and the diagnostic value of ultrasound-guided biopsy was analyzed. Meanwhile, complications during and after puncture were recorded. SPSS 24.0 software was used for statistical analysis.The measurement data were expressed as x±s and enumeration data were expressed as rate,if the P value was less than 0.05, it indicated that the difference was statistically significant. Results: There were 32 malignant cases and 27 benign cases based on the final pathological diagnosis. The sensitivity and specificity of ultrasound-guided needle biopsy were 100%, in contrast, the enhanced MRI was 96.9% and 81.5%, respectively, with the former significantly higher than the latter. There were no abdominal bleeding,infections and pneumothoraxduring and after the puncture. Conclusion: Ultrasound-guided puncture biopsy and enhanced MRI are both safe for the diagnosis of AFP negative liver occupying lesions,but the former is more sensitive than the latter.When the clinical symptoms of the patient are relatively mild and there is uncertainty in the diagnosis due to the lack of specific enhanced imaging, ultrasound-guided puncture is more conducive to identifying the nature of the lesion.


Assuntos
Biópsia por Agulha/métodos , Hepatopatias/diagnóstico , Ultrassonografia de Intervenção , Adulto , Idoso , Feminino , Humanos , Fígado , Masculino , Pessoa de Meia-Idade , Punções , Estudos Retrospectivos , Sensibilidade e Especificidade , alfa-Fetoproteínas/análise
18.
Med Sci Monit ; 26: e921350, 2020 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-32200388

RESUMO

BACKGROUND To facilitate early treatment, we constructed a nomogram to predict risk of postoperative fever before prostate biopsy in patients with high risk of fever. MATERIAL AND METHODS We collected information on patients undergoing prostate biopsy from January 2015 to December 2018 from their medical records, including clinical characteristics and laboratory test results. Finally, after strict screening, the prediction model was established in 440 patients who underwent a transrectal prostate biopsy (TRPB). We divided these patients into a training group and validation group at a ratio of 7: 3, respectively. Univariate analysis and multivariate logistic regression analysis were used to select the predictors and to develop the model. Calibration curve and C-index were used to evaluate the accuracy of the nomogram, while DCA was used to assess the clinical value. RESULTS The individualized predictive nomogram contained 3 clinical features - Biopsy-positive rate (BPR), Hematuria, and Urine WBC - significantly associated with post-biopsy fever. The nomogram had good discriminating ability in both the training group and validation group - the C-index was 0.774 (95% CI=0.717-0.832) in the training group and 0.808 (95% CI=0.706-0.909) in the validation group. Hosmer-Lemeshow test proved a good calibration curve fit. The DCA curve suggested that the nomogram would have good clinical utility. CONCLUSIONS This is the first study to develop a nomogram to predict fever after prostate biopsy via Biopsy-positive rate (BPR), Hematuria, and Urine WBC. Use of this nomogram might help prevent fever and infection, and could facilitate individualized medical treatment after prostate biopsy.


Assuntos
Biópsia por Agulha/efeitos adversos , Febre/epidemiologia , Nomogramas , Neoplasias da Próstata/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/métodos , Hematúria , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Valor Preditivo dos Testes , Próstata/patologia , Doenças Prostáticas/diagnóstico , Doenças Prostáticas/patologia , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Ultrassonografia de Intervenção , Urina/citologia
19.
World Neurosurg ; 138: e806-e818, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32222551

RESUMO

OBJECTIVE: Primary sacral tumors pose unique challenges because of their complex radiographic appearances, diverse pathologic entities, and dramatically different treatment paradigms based on tumor type. Magnetic resonance imaging and computed tomography (CT) can provide valuable information; however, sacral lesions can possess unique radiographic features and pose diagnostic dilemmas. CT-guided percutaneous needle biopsy is a critical component of the diagnostic workup. However, limited data are available on its efficacy for primary sacral tumors. METHODS: The data from patients with newly diagnosed primary sacral lesions during a 12-year period at our hospital were analyzed. The preoperative magnetic resonance imaging findings, biopsy results, and pathological data for patients who required surgery were analyzed. Unique cases in which the final pathologic result was unexpected from the preoperative imaging findings have been highlighted. RESULTS: Of 38 patients who underwent percutaneous needle biopsy, diagnostic tissue was obtained on the first attempt for 31 (82%). Five of the remaining 7 obtained diagnostic tissue on the second attempt, yielding 95% diagnosis, with only two requiring open biopsies. In 2 patients with diagnostic tissue on CT-guided biopsy, an open biopsy was still recommended because of the clinical scenario. In both patients, the open biopsy results matched those of the CT-guided biopsy. For the 18 patients who required surgery, we found 100% correlation between the percutaneous needle biopsy findings and the final pathological diagnosis. No biopsy-induced complications or extraspinal tumor seeding occurred. CONCLUSIONS: CT-guided biopsy is a safe and effective technique. It represents a critical component of the diagnostic algorithm, given the diverse pathological findings of primary sacral lesions and dramatic differences in treatment.


Assuntos
Biópsia por Agulha/métodos , Sacro/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Biópsia Guiada por Imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Sacro/patologia , Neoplasias da Coluna Vertebral/patologia , Adulto Jovem
20.
Rev. senol. patol. mamar. (Ed. impr.) ; 33(1): 3-8, ene.-mar. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-193240

RESUMO

OBJETIVO: Evaluar el rendimiento de la biopsia por punción (BPP) en el diagnóstico de tumor filodes (TF) de la mama. MATERIAL Y MÉTODOS: Se han revisado todos los diagnósticos anatomopatológicos de TF emitidos tanto en BPP como en biopsia quirúrgica (BQ). Se analizan las características clínicas, de imagen y patológicas de los casos y la concordancia diagnóstica entre la BPP y la BQ. RESULTADO: Se han estudiado un total de 87 casos con diagnóstico de TF, 16 en BPP y 71 en BQ. En 18 casos se dispuso de BPP y BQ. Los TFB diagnosticados en BPP fueron: 7 FAD (uno de ellos de la variedad celular), 2 TFB, un TFL, 2TFM y un hamartoma. Dos casos de TFB en BQ habían sido diagnosticados respectivamente en la BPP de fibrosis e hiperplasia. Un TFM en BPP resultó ser un TFL en la BQ. Hubo concordancia diagnóstica en un TFL y un TFM. Se detectaron 5 (27%) falsos negativos y 8 falsos positivos (38%). CONCLUSIONES: El rendimiento de la BPP en el diagnóstico de los TF es bajo con una alta tasa de falsos negativos y falsos positivos. Por ello se aconseja emitir un diagnóstico en la BPP de lesión fibroepitelial con estroma celular dejando pendiente un diagnóstico definitivo a disponer de la BQ


OBJECTIVE: To evaluate the role of core needle biopsy (CNB) in the diagnosis of phyllodes tumour (PT) of the breast. MATERIAL AND METHODS: All pathological diagnoses of PT in both CNB and surgical biopsy (SB) were reviewed. The clinical, imaging and pathological characteristics of the cases and the diagnostic agreement between CNB and SB were analysed. RESULT: A total of 87 cases with a diagnosis of PT, 16 in CNB and 71 in SB, were studied. In 18 cases, CNB and SB were available. Benign PT diagnosed in CNB consisted of: 7 fibroadenomas (one of them cellular), 2 benign PT, 1 borderline PT, 2 malignant PT, and 1 hamartoma. Two cases of benign PT in SB had been diagnosed with CNB as fibrosis and hyperplasia. One PT diagnosed as malignant in CNB was diagnosed as a borderline PT in SB. There was diagnostic agreement in 1 borderline PT and 1 malignant PT. We detected 5 (27%) false negatives and 8 false positives (38%). CONCLUSIONS: The efficiency of CNB in the diagnosis of PT is low, with a high rate of false negatives and false positives. Therefore, it is advisable to suggest a diagnosis of fibroepithelial lesion with cellular stroma in CNB, reserving definitive diagnosis to SB


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Biópsia por Agulha/métodos , Neoplasias da Mama/patologia , Tumor Filoide/patologia , Reações Falso-Negativas , Reações Falso-Positivas
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