Shape-Sensing Robotic-Assisted Bronchoscopy versus Computed Tomography-Guided Transthoracic Biopsy for the Evaluation of Subsolid Pulmonary Nodules.

INTRODUCTION: Lung cancer remains the leading cause of cancer death worldwide. Subsolid nodules (SSN), including ground-glass nodules (GGNs) and part-solid nodules (PSNs), are slow-growing but have a higher risk for malignancy. Therefore, timely diagnosis is imperative. Shape-sensing robotic-assisted bronchoscopy (ssRAB) has emerged as reliable diagnostic procedure, but data on SSN and how ssRAB compares to other diagnostic interventions such as CT-guided transthoracic biopsy (CTTB) are scarce. In this study, we compared diagnostic yield of ssRAB versus CTTB for evaluating SSN. METHODS: A retrospective study of consecutive patients who underwent either ssRAB or CTTB for evaluating GGN and PSN with a solid component less than 6 mm from February 2020 to April 2023 at Mayo Clinic Florida and Rochester. Clinicodemographic information, nodule characteristics, diagnostic yield, and complications were compared between ssRAB and CTTB. RESULTS: A total of 66 nodules from 65 patients were evaluated: 37 PSN and 29 GGN. Median size of PSN solid component was 5 mm (IQR: 4.5, 6). Patients were divided into two groups: 27 in the ssRAB group and 38 in the CTTB group. Diagnostic yield was 85.7% for ssRAB and 89.5% for CTTB (p = 0.646). Sensitivity for malignancy was similar between ssRAB and CTTB (86.4% vs. 88.5%; p = 0.828), with no statistical difference. Complications were more frequent in CTTB with no significant difference (8 vs. 2; p = 0.135). CONCLUSION: Diagnostic yield for SSN was similarly high for ssRAB and CTTB, with ssRAB presenting less complications and allowing mediastinal staging within the same procedure.

Robotic-assisted bronchoscopy versus CT-guided transthoracic biopsy for diagnosis of pulmonary nodules.

BACKGROUND AND OBJECTIVE: Currently, computed tomography-guided transthoracic biopsy (CTTB) is the most accurate diagnostic approach for pulmonary nodules suspected of malignancy. Traditional bronchoscopy has shown suboptimal diagnostic sensitivity, but the emergence of robotic-assisted bronchoscopy (RAB) has the potential to improve diagnostic accuracy, maximize diagnostic yield and complete mediastinal and hilar staging in a single procedure. We aim to assess the efficacy and diagnostic performance of RAB compared to CTTB for diagnosing pulmonary nodules suspected of lung cancer. METHODS: A multicenter retrospective review of consecutive patients who underwent RAB and CTTB for evaluating pulmonary nodules from January 2019 to March 2021 at Mayo Clinic Florida and Mayo Clinic Rochester, United States. Clinical and demographic information, nodule characteristics, outcomes and complications were compared between RAB and CTTB. RESULTS: A total of 225 patients were included: 113 in the RAB group and 112 in the CTTB group. Overall diagnostic yield was 87.6% for RAB and 88.4% for CTTB. For malignant disease, RAB had a sensitivity of 82.1% and a specificity of 100%, CTTB had a sensitivity of 88.5% and a specificity of 100%. Complication rate was significantly higher for CTTB compared to RAB (17% vs. 4.4%; p = 0.002). CONCLUSION: RAB, when available, can be as accurate as CTTB for sampling pulmonary nodules with similar or reduced complications and should be considered as a means for nodule biopsy, particularly when mediastinal staging is also clinically warranted.

Solitary Lung Nodule: CT-Guided Transthoracic Biopsy vs Transbronchial Biopsy With Endobronchial Ultrasound and Flexible Bronchoscope, a Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Transbronchial lung biopsy with radial endobronchial ultrasound (rEBUS-TBB) and Computed tomography (CT) scan-guided transthoracic biopsy (CT-TTB) are commonly used to investigate peripheral lung nodules but high-quality data are still not clear about the diagnostic and safety profile comparison of these two modalities. METHOD: We included all randomized controlled trials (RCT) comparing rEBUS-TBB with a flexible bronchoscope and CT-TTB for solitary lung nodules. Two reviewers extracted data independently on diagnostic performance and complication rates. RESULTS: 170 studies were screened, 4 RCT with a total of 325 patients were included. CT-TTB had a higher diagnostic yield than rEBUS-TBB (83.45% vs 68.82%, risk difference - 0.15, 95% CI, [- 0.24, - 0.05]), especially for lesion size 1-2 cm (83% vs 50%, risk difference - 0.33, 95% CI, [- 0.51, - 0.14]). For malignant diseases, rEBUS-TBB had a diagnostic yield of 75.75% vs 87.7% of CT-TTB. rEBUS-TBB had a significant better safety profile with lower risks of pneumothorax (2.87% vs 21.43%, OR = 0.12, 95% CI [0.05-0.32]) and combined outcomes of hospital admission, hemorrhage, and pneumothorax (8.62% vs 31.81%, OR 0.21, 95% CI, [0.11-0.40]). Factors increasing diagnostic yield of rEBUS were lesion size and localization of the probe but not the distance to the chest wall and hilum. CONCLUSION: CT-TTB had a higher diagnostic yield than rEBUS-TBB in diagnosing peripheral lung nodules, particularly for lesions from 1 to 2 cm. However, rEBUS-TBB was significantly safer with five to eight times less risk of pneumothorax and composite complications of hospital admission, hemorrhage, and pneumothorax. The results of this study only apply to flexible bronchoscopy with radial ebus without navigational technologies. More data are needed for a comparison between CT-TTB with rEBUS-TBB combined with advanced navigational modalities.

[Coaxial system with permanent infiltration anesthesia for ct-assisted transthoracic trepanobiopsy of lung tumors]. / Transtorakal'naya trepanobiopsiya obrazovanii legkogo pod KT-navigatsiei s ispol'zovaniem koaksial'noi sistemy.

OBJECTIVE: To assess irradiation time, pain syndrome and safety of the proposed device and technique compared to conventional CT-assisted transthoracic biopsy. MATERIAL AND METHODS: CT-guided transthoracic trepanobiopsy of thoracic tumors was carried out in 296 patients between January 2017 and January 2020. There were 189 (63.8%) men and 107 (36.2%) women. Mean age of patients was 64.1±9.6 years (range 35-83). All patients were randomized into 2 groups by 148 people: group 1 - morphological verification via conventional CT-guided transthoracic trepanobiopsy, group 2 - morphological verification using a coaxial system and a specially developed CT-guided transthoracic trepanobiopsy. RESULTS: Coaxial system with permanent anesthesia in CT-guided transthoracic manipulations reduces post-manipulation complications by 4-5%, get more qualitative morphological material (by 4%), reduces the time of procedure by 2 times and irradiation of patients by 27%, excludes irradiation of physicians and significantly reduces pain syndrome.

Measures to Prevent Air Embolism in Transthoracic Biopsy of the Lung.

OBJECTIVE: Systemic air embolism (AE) is a rare but feared complication of transthoracic biopsy with potentially fatal consequences. The aim of the study was to assess the effect of patient positioning during transthoracic biopsy on preventing systemic AE. MATERIALS AND METHODS: We compared a historical control group of 610 patients (group 1) who underwent transthoracic biopsy before the implementation of measures to prevent systemic AE during transthoracic biopsy and a group of 1268 patients (group 2) who underwent biopsy after the measures were implemented. The patients in group 2 were placed in the ipsilateral-dependent position so that the lesion being biopsied was located below the level of the left atrium. RESULTS: The rate of systemic AE was reduced from 3.77% to 0.16% (odds ratio [OR], 0.040; 95% CI, 0.010-0.177; p < 0.001). Logistic regression analyses identified needle penetration depth, prone position of the patient during biopsy, location above the level of the left atrium, needle path through ventilated lung, and intubation anesthesia as independent risk factors for systemic AE (p < 0.05). Propensity score-matched analyses identified the number of biopsy samples obtained as an additional risk factor (p = 0.003). The rate of pneumothorax was reduced from 15.41% in group 1 to 5.99% in group 2 (OR, 0.374; 95% CI, 0.307-0.546; p < 0.001). CONCLUSION: Performing transthoracic biopsy with the patient in an ipsilateral-dependent position so that the lesion is located below the level of the left atrium is an effective measure for preventing systemic AE. Needle path through ventilated lung and intubation anesthesia should be avoided whenever possible.

US-guided transthoracic biopsy of peripheral lung lesions: pleural contact length influences diagnostic yield.

BACKGROUND: Transthoracic biopsy of peripheral lung lesions under ultrasonography (US) guidance is a useful diagnostic technique. However, factors affecting diagnostic yield of US-guided transthoracic biopsy of peripheral lung lesions are not well established. PURPOSE: To determine the factors that influence diagnostic yield of US-guided transthoracic biopsy in peripheral lung lesions. MATERIAL AND METHODS: A total of 100 consecutive patients underwent US-guided percutaneous cutting biopsy of peripheral lung lesions from October 2007 to March 2009. After seven unconfirmed cases were excluded, 97 procedures in 93 consecutive patients were included in this study. The accuracy of the lung biopsies was assessed by comparing the biopsy results with the final diagnoses. We divided the cases into a correct group (true-positive and true-negative) and an incorrect group (false-positive, false-negative, and non-diagnostic results) and analyzed the differences in the lesions, procedures, and patient variables between the two groups. RESULTS: According to the final diagnoses, 56 cases (57.7%) were malignant and 41 cases (42.3%) were benign. An overall diagnostic accuracy of 91.8% was obtained. The median size of the lesions was 46.0 mm (interquartile range [IQR], 30.0-69.5 mm), and the median lesion-pleura contact arc length (LPCAL) was 31.0 mm (IQR, 18.0-51.0 mm). Multivariate logistic regression analysis showed that only LPCAL (odds ratio, 1.16; 95% CI, 1.04-1.30) was a significant predictor of a correct diagnosis. When we divided the lesions into those with LPCAL values >30 mm and LPCAL values ≤30 mm, the sensitivity (96.6% vs. 74.1%; P = 0.02) and the accuracy (98% vs. 85.4%; P = 0.03) were significantly higher in the group with larger LPCAL. CONCLUSION: In US-guided transthoracic biopsy of peripheral lung lesions, the LPCAL of the lesions is an important factor for a correct diagnosis.

Pre-procedure 18F-FDG PET/CT imaging improves the performance of CT-guided transthoracic biopsy.

PURPOSE: To compare computed tomography (CT)-guided transthoracic lung biopsies (CTLB) with and without pre-procedure 18F-fluorodeoxgyglucose positron emission tomography (18F-FDG PET)/CT images in the diagnosis of pulmonary nodules/masses. METHODS: This is a case-control study in a single center. The data of patients with a transthoracic lung biopsy guided by CT and pre-procedure 18F-FDG PET/CT (group 2, here called the "PETCTLB" group), including demographics, clinical characteristics, and biopsy-related parameters, were collected. The PET/CT scan was performed within 15 days before the biopsy. The data from patients with CTLB were used as controls (group 1). Biopsies for all patients were performed by the same physician between January 2019 and December 2021. The final diagnosis was based on surgical outcomes, or imaging findings, and the results of at least one 6-month follow-up. The demographics and clinical characteristics of patients, lesions and biopsy-related variables, diagnostic yields, and incidence of complications were compared between the two groups. Two-tailed t-tests were used to compare the mean values in the two independent groups, while categorical variables were compared using the Pearson chi-squared test, and P values < 0.05 were considered to be significant. RESULTS: A total of 84 patients were included, and 84 biopsies of 84 lung nodules/masses were analyzed. The demographics and clinical characteristics of group 2 (n = 39; 21 men; mean age, 63.2 ± 9.29 years) and group 1 (n = 45; 30 men; mean age, 61.2 ± 12.3 years) had no significant difference (P = 0.230 and 0.397, respectively). The procedure duration (11.1 ± 3.0 vs. 12.9 ± 3.3 minutes, P = 0.008), the number of samples (2.6 ± 0.5 vs. 3.1 ± 0.4, P < 0.001), diagnostic accuracy (97.4% vs. 82.2%, P = 0.033), and bleeding complication (25.6% vs. 42.2%, P = 0.034) of group 2 and group 1 were statistically different. CONCLUSION: A biopsy guided by CT plus pre-procedure 18F-FDG PET/CT (PETCTLB) is a safe procedure that can provide a precise diagnosis in the majority of lung nodules/masses. It has better diagnostic performance than CTLB.

Systemic air embolism following computed-tomography-guided transthoracic needle biopsy of lung lesion - a systematic search of case reports and case series.

Background: Systemic air embolism is a rare, however potentially fatal, low incidence, complication to CT-guided transthoracic needle biopsy of lung lesions. Purpose: The purpose of this review of case reports and series was to pool data about this rare complication and glance for a pattern or similarities in the patients' initial symptoms and course, as well as the management of the patients in relation to current guidelines. Material and methods: PubMed was searched for case reports and case series about systemic air embolisms following CT-guided transthoracic needle biopsy of lung lesions from inception to November 2021. A reviewer screened the results for eligibility and included studies which reported at least two outcomes of interest. Data was extracted by one author and a descriptive analysis was conducted. Results: Of 1,136 studies screened, 83 were eligible for inclusion involving 97 patients. The mean age was 64.8±11.7 years and ≈60% of the patients were men. In 15 cases the outcome was fatal, and most of the fatal cases (n = 12) had cardiac arrest as the primary initial symptom. In addition to conventional oxygen therapy, 34 patients received hyperbaric oxygen therapy, and in 30 cases the physician in charge chose to change the patient from standard supine position to - most often - Trendelenburg position. Conclusion: No similarities were found that could lead to more rapid diagnosis or more correct management. The staff should keep systemic air embolisms in mind, when more common complications are ruled out, and consider hyperbaric oxygen therapy in case of suspicion.

Ewing Sarcoma of the Lung: Imaging of a Rare Tumor.

Primary pulmonary Ewing sarcoma is an extremely rare tumor of neuroectodermal tissue. In this article, we report on the case of a 45-year-old female who presented in the emergency department with shortness of breath and night fever. Radiologic findings suggested a massive pulmonary mass and a metastatic liver lesion. The diagnosis of Ewing sarcoma was established through a percutaneous biopsy of the lung mass and liver lesion. We highlight the importance of considering a broad differential diagnosis for a large pulmonary mass in order to lead to a prompt diagnosis and treatment.

Percutaneous Image-Guided Biopsy for a Comprehensive Hybridization Capture-Based Next-Generation Sequencing in Primary Lung Cancer: Safety, Efficacy, and Predictors of Outcome.

Introduction: To evaluate factors associated with successful comprehensive genomic sequencing of image-guided percutaneous needle biopsies in patients with lung cancer using a broad hybrid capture-based next-generation sequencing assay (CHCA). Methods: We conducted a single-institution retrospective review of image-guided percutaneous transthoracic needle biopsies from January 2018 to December 2019. Samples with confirmed diagnosis of primary lung cancer and for which CHCA had been attempted were identified. Pathologic, clinical data and results of the CHCA were reviewed. Covariates associated with CHCA success were tested for using Fisher's exact test or Wilcoxon ranked sum test. Logistic regression was used to identify factors independently associated with likelihood of CHCA success. Results: CHCA was requested for 479 samples and was successful for 433 (91%), with a median coverage depth of 659X. Factors independently associated with lower likelihood of CHCA success included small tumor size (OR = 0.26 [95% confidence interval (CI): 0.11-0.62, p = 0.002]), intraoperative inadequacy on cytologic assessment (OR = 0.18 [95% CI: 0.06-0.63, p = 0.005]), small caliber needles (≥20-gauge) (OR = 0.22 [95% CI: 0.10-0.45, p < 0.001]), and presence of lung parenchymal abnormalities (OR = 0.12 [95% CI: 0.05-0.25, p < 0.001]). Pneumothorax requiring chest tube insertion occurred in 6% of the procedures. No grade IV complications or procedure-related deaths were reported. Conclusions: Percutaneous image-guided transthoracic needle biopsy is safe and has 91% success rate for CHCA in primary lung cancer. Intraoperative inadequacy, small caliber needle, presence of parenchymal abnormalities, and small tumor size (≤1 cm) are independently associated with likelihood of failure.

Computed Tomography-Guided Transthoracic Needle Biopsy: Predictors for Diagnostic Failure and Tissue Adequacy for Molecular Testing.

Background: Adequate and representative tissue from lung tumor is important in the era of precision medicine. The aim of this study is to identify detailed procedure-related variables and factors influencing diagnostic success and tissue adequacy for molecular testing in CT-guided TTNB. Methods: Consecutive patients undergoing CT-guided TTNB were retrospectively enrolled between January 2013 and May 2020. Multivariate analysis was performed for predictors for diagnostic accuracy and tissue adequacy for molecular testing. Logistic regression was used to identify risk factors for procedure-related complications. Results: A total of 2,556 patients undergoing CT-guided TTNB were enrolled and overall success rate was 91.5% (2,338/2,556). For lung nodules ≤3 cm, predictors for diagnostic success included coaxial needle use [OR = 0.34 (0.16-0.71), p = 0.004], CT scan slice thickness of 2.5 mm [OR = 0.42 (0.15-0.82), p = 0.011] and additional prefire imaging [OR = 0.31 (0.14-0.68), p = 0.004]. For lung tumor >3 cm, ground glass opacity part more than 50% [OR = 7.53 (2.81-20.23), p < 0.001] or presence of obstructive pneumonitis [OR = 2.31 (1.53-3.48), p < 0.001] had higher risk of diagnostic failure. For tissue adequacy, tissue submitted in two cassettes (98.9 vs. 94.9%, p = 0.027) was a positive predictor; while male (5.7 vs. 2.5%, p = 0.032), younger age (56.61 ± 11.64 vs. 65.82 ± 11.98, p < 0.001), and screening for clinical trial (18.5 vs. 0.7%, p < 0.001) were negative predictors. Conclusions: Using a coaxial needle, with thin CT slice thickness (2.5 mm), and obtaining additional prefire imaging improved diagnostic success, while obtaining more than two tissue cores and submitting in two cassettes improved tissue adequacy for molecular testing.

Rare Pulmonary Tumors and Carcinoma Mimickers; Experience from an Interventional Radiology Unit with Radiologic-pathologic Correlation- A Pictoral Essay.

BACKGROUND: Although imaging findings along with patients' clinical history may give a clue for the etiology of a pulmonary lesion, the differentiation of benign pulmonary lesions from lung cancer could be challenging. OBJECTIVE: The aim of this review article was to increase the awareness of carcinoma mimicking lung lesions. METHODS: This paper was designed to illustrate rare pulmonary tumors and carcinoma mimickers with emphasis on radiologic-pathologic correlation. Pitfalls encountered on CT images and also false positivity of PET-CT scans were also presented. CONCLUSION: Several benign pulmonary lesions may grow in size on follow-up and some may show pathologic FDG (18F-fluorodeoxyglucose) uptake, which makes them indistinguishable from lung carcinoma by imaging. In addition, some slow-growing malignant lesions, such as carcinoid, may be false-negative on PET/CT scans.

CT Fluoroscopy Guided Thoracic Biopsies (CTTB) Are Highly Accurate and Safe: Outcomes and Predictive Modeling of Complications Utilizing Machine Learning.

PURPOSE: CT guided transthoracic biopsy (CTTB) is an established, minimally invasive method for diagnostic evaluation of a variety of thoracic diseases. We assessed a large CTTB cohort diagnostic accuracy, complication rates, and developed machine learning models to predict complications. MATERIALS AND METHODS: We retrospectively identified 796 CTTB patients in a tertiary hospital (5-year interval). We gathered and coded patient demographics, characteristics of each lesion biopsied, type of biopsy, diagnostic yield, type of diagnosis, and complication rates. Statistical analyses included summary statistics, multivariate logistic regression and machine learning (neural network) methods. RESULTS: Seven hundred ninety-six CTTBs were performed (43% fine needle aspirations, 5% core biopsies, 52% both). Diagnostic yield was 97.0% (73.9% malignant, 23.1% benign). Complications occurred in 14.7% (12.7% minor, 2.0% major). The most common complication was pneumothorax (13.1%), mostly minor. Multivariate logistic regression models could predict severity of complications with accuracies ranging from 65.5% to 83.5%, with smaller lesion dimension the strongest predictor. Type of biopsy was not a statistically significant predictor. A neural network model improved accuracy to 77.0%-94.2%. CONCLUSION: CTTB performed by thoracic radiologists in a tertiary hospital demonstrate excellent diagnostic yield (97.0%) with a low clinically important complication rate (2.0%). Machine learning methods including neural networks can accurately predict the likelihood of complications, offering pathways to potentially improve patient selection and procedural technique, in order to further optimize the risk-benefit ratio of CTTB.

Cone-Beam CT-Guided Lung Biopsies: Results in 94 Patients.

BACKGROUND: The aim of this study was to evaluate the diagnostic capacity of Cone-Beam computed tomography (CT)-guided transthoracic percutaneous biopsies on lung lesions in our setting and to detect risk factors for possible complications. METHODS: Retrospective study of 98 biopsies in 94 patients, performed between May 2017 and January 2020. To obtain them, a 17G coaxial puncture system and a Siemens Artis Zee Floor vc21 archwire were used. Descriptive data of the patients, their position at the time of puncture, location and size of the lesions, number of cylinders extracted, and complications were recorded. Additionally, the fluoroscopy time used in each case, the doses/area and the estimated total doses received by the patients were recorded. RESULTS: Technical success was 96.8%. A total of 87 (92.5%) malignant lesions and 3 (3.1%) benign lesions were diagnosed. The sensitivity was 91.5% and the specificity was 100%. We registered three technical failures and three false negatives initially. Complications included 38 (38.8%) pneumothorax and 2 (2%) hemoptysis cases. Fluoroscopy time used in each case was 4.99 min and the product of the dose area is 11,722.4 microGy/m2. CONCLUSION: The transthoracic biopsy performed with Cone-Beam CT is accurate and safe in expert hands for the diagnosis of lung lesions. Complications are rare and the radiation dose used was not excessive.

Hemoptysis complicating ultrasound-guided transthoracic needle lung biopsy: air bronchial sign is a risk predictor.

BACKGROUND: Hemoptysis is the most frequently reported complication of ultrasound-guided transthoracic needle lung biopsy (US-TTLB). However, factors influencing the occurrence of hemoptysis as a result of US-TTLB remain uncertain. Therefore, the aim of this study was to evaluate the incidence of hemoptysis as a complication of US-TTLB and to identify the related risk factors. METHODS: We retrospectively analyzed all data of patients who underwent US-TTLB from February 2013 through December 2016. The incidence, severity, and treatment of hemoptysis in each case were carefully recorded. Study variables were classified into patient-related factors (age, sex, smoking history, pulse oxygen saturation, laboratory tests and emphysema), biopsy-related factors (use of contrast agent, number of punctures and operators), and lesion-related factors (lesion location, size, pathology, length of puncture path and the grade of air bronchial sign). Univariate and multivariate logistic regression analyses were performed to analyze the risk factors of hemoptysis. We investigated whether incidence of hemoptysis increased according to increased grade of air bronchial sign by Mantel-Haenszel test. RESULTS: A total of 209 patients were evaluated. Hemoptysis occurred in 20 of the 209 patients (9.6%). In univariate analysis, the lesion pathology (P=0.037) and grade of air bronchial sign (P<0.001) were statistically significant factors between the hemoptysis group and the non-hemoptysis group. In multivariate analysis, the presence of multi-air bronchogram in sonographic image (odds ratio =8.946; 95% confidence interval: 2.873-27.863; P<0.001) was a statistically significant predictive risk factor for hemoptysis complicating US-TTLB. There was a significant tendency for incidence of hemoptysis with the grade of air bronchial sign (P<0.001). CONCLUSIONS: We found that the rate of hemoptysis complicating US-TTLB was 9.6% and the severity of hemoptysis was not serious. Target lesion without air bronchogram is a safety sign, minor bronchogram means relatively low-risk, while multiple bronchogram is a highly dangerous ultrasound sign of hemoptysis.

Computed Tomography-guided Transthoracic Core Needle Biopsy of Lung Masses: Technique, Complications and Diagnostic Yield Rate.

OBJECTIVES: Computed tomography-guided core needle biopsy has an important role in the accurate histopathological diagnosis of lung masses. The present study aims to share our results of computed tomography-guided percutaneous core needle biopsy of lung masses. METHODS: A total of 117 patients had computed tomography-guided percutaneous core needle biopsy for lung masses between January 2017-September 2019 in our institution. In this study, these patients' post-procedural complications, diagnostic-yield-rates and radiological-histopathological correlations were evaluated retrospectively. RESULTS: Complications occurred in 23 (20%) patients (20 (17%) of pneumothorax; 3 (3%) of hemorrhage). Chest-tube-drainage was needed in five (4%) of all patients. No significant difference was found between complication rates and patient gender/age, tumor volume/localization or needle-path-length (p>0.05). In 77 of the 85 (91%) primary-lung-cancer-cases radiological and pathological diagnostic results were correlated. CONCLUSION: Computed tomography-guided core needle biopsy has a high diagnostic yield rate with acceptable complication rates in the diagnosis of lung masses.

Case report: Pulmonary amyloidosis in two patients with chronic obstructive lung disease (COPD).

We present two cases of patients with chronic obstructive lung disease (COPD) who developed different forms of pulmonary amyloidosis. In both cases malignancy was considered as primary diagnosis. Transthoracic biopsy confirmed pulmonary amyloidosis. In the first case the patient presented with progressive dyspnoea over a two years period. Initial assessment was consistent with a diagnosis of COPD but progressive changes in symptoms and lung functions and subsequently CT Thorax revealed possible airway obstruction. Bronchoscopy confirmed an obstructive lesion initially considered to be malignant but was found to be due to tracheobronchial amyloid (TBA). Our second case presented with symptoms and signs consistent with COPD. Follow up chest X-rays revealed a pulmonary nodule which on CT examination was considered to be malignant. Transthoracic biopsy confirmed pulmonary amyloidosis. Although it is a rare condition amyloid disease should to consider as the part of the differential diagnosis in COPD patients who present with signs and symptoms consistent with pulmonary malignancy.

Study Design and Rationale: A Multicenter, Prospective Trial of Electromagnetic Bronchoscopic and Electromagnetic Transthoracic Navigational Approaches for the Biopsy of Peripheral Pulmonary Nodules (ALL IN ONE Trial).

BACKGROUND: Pulmonary nodules are a common but difficult issue for physicians as most identified on imaging are benign but those identified early that are cancerous are potentially curable. Multiple diagnostic options are available, ranging from radiographic surveillance, minimally invasive biopsy (bronchoscopy or transthoracic biopsy) to more invasive surgical biopsy/resection. Each technique has differences in diagnostic yield and complication rates with no established gold standard. Currently, the safest approach is bronchoscopic but it is limited by variable diagnostic yields. Percutaneous approaches are limited by nodule location and complications. With the recent advent of electromagnetic navigation (EMN), a combined bronchoscopic and transthoracic approach is now feasible in a single, staged procedure. Here, we present the study design and rationale for a single-arm trial evaluating a staged approach for the diagnosis of pulmonary nodules. METHODS: Participants with 1-3 cm, intermediate to high-risk pulmonary nodules will undergo a staged approach with endobronchial ultrasound (EBUS) followed by EMN-bronchoscopy (ENB), then EMN-transthoracic biopsy (EMN-TTNA) with the procedure terminated at any stage after a diagnosis is made via rapid onsite cytopathology. We aim to recruit 150 EMN participants from eight academic and community settings to show significant improvements over other historic bronchoscopic guided techniques. The primary outcome is overall diagnostic yield of the staged approach. CONCLUSION: This is the first study designed to evaluate the diagnostic yield of a staged procedure using EBUS, ENB and EMN-TTNA for the diagnosis of pulmonary nodules. If effective, the staged procedure will increase minimally invasive procedural diagnostic yield for pulmonary nodules.

Complications of CT-guided transthoracic lung biopsy : A short report on current literature and a case of systemic air embolism.

Percutaneous computed tomography (CT)-guided transthoracic needle biopsy (PCNB) is a common diagnostic procedure and is especially indispensable in thoracic oncology. Complications, such as pulmonary hemorrhage and pneumothorax are frequent, but usually easy to manage. Systemic air embolism is a rare but relevant adverse event and its true incidence is probably underestimated, as not all cases may become clinically apparent. We present a case of systemic air embolism following a core-needle biopsy of a left upper lobe lesion, where immediately after the procedure CT scans documented air in the thoracic aorta and in the left ventricle. In this context, we review the current literature on technical aspects as well as on frequent and infrequent major complications of PCNB, together with risk factors, emergency treatment and prevention strategies.

Sensitivity of Computed Tomography-guided Transthoracic Biopsies in a Nigerian Tertiary Institution.

INTRODUCTION: The indications for open biopsies for intrathoracic lesions have become almost negligible. This development was made possible by less invasive maneuvers such as computed tomography-guided (CT-guided) biopsy, thoracoscopy or video-assisted thoracoscopy, and bronchoscopy. CT-guided percutaneous lung biopsy was first reported in 1976. AIM OF STUDY: The aim of the study is to report our experience with CT-guided transthoracic biopsy. MATERIALS AND METHODS: Patients with clinical and radiological evidence of intrathoracic mass were counseled and consent obtained for the procedure. They were positioned in the gantry, either supine or prone. A scout scan of the entire chest was taken at 5 mm intervals. The procedure was carried out by the consultants and senior registrar. Following visualization of the lesion, its position in terms of depth and distance from the midline was measured with the machine in centimeter to determine the point of insertion of the trucut needle (14-18-G). The presumed site of the lesion was indicated with a metallic object held in place with two to three strips of plasters after cleaning the site with Povidone-iodine. After insertion, repeat scans were performed to confirm that the needle was within the mass. A minimum of 3 core cuts was taken to be certain that the samples were representative. The results were analyzed by the determination of means and percentages. RESULTS: Twenty-six patients underwent this procedure between 2011 and 2015. There were 15 males and 11 females (M:F = 1.4:1). The age range was between 30 and 99 years with a mean of 55 years. Histological diagnosis was obtained in 24 of the patients giving sensitivity of 92.3%. There were 3 mild complications giving a rate of 11.5%. The complications included a case of mild hemoptysis and two patients who had mild pneumothoraces which did not require tube thoracostomy. CONCLUSION: CT-guided biopsy is a reliable procedure for obtaining deep-seated intrathoracic biopsies with high sensitivity and minimal complication rate.