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Erschienen in: European Radiology 8/2017

03.01.2017 | Oncology

CT-guided core needle biopsy of mediastinal nodes through a transpulmonary approach: retrospective analysis of the procedures conducted over six years

verfasst von: Zhongyuan Yin, Zhiwen Liang, Pengcheng Li, Qiong Wang

Erschienen in: European Radiology | Ausgabe 8/2017

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Abstract

Purpose

To retrospectively evaluate the diagnostic performance and complications of a CT-guided core needle cutting biopsy of mediastinal nodes through a transpulmonary approach.

Materials and methods

From January 2009 to December 2014, we used a coaxial positioning system and an 18G cutting-type biopsy device to perform CT-guided percutaneous transpulmonary needle biopsies of mediastinal nodes for 127 patients. The diagnostic performance, complication rate, influencing factors, distribution of mediastinal nodes and pathological diagnoses were investigated.

Results

Among 127 patients, pathologic analyses showed that all of the biopsies were technically successful. The sensitivity, specificity, positive predictive value, and negative predictive value were all 100%. As for complications, the ratios for pneumothorax and hemoptysis were 33.9% and 4.7%, respectively. Multivariate analyses revealed that the distance from the pleura to the target lesion (P = 0.008) and the numbers of visceral pleura injuries (P = 0.006) were the two most significant risk factors for pneumothorax, and that the distance from the pleura to the target lesion (P = 0.004) was the most significant risk factor for hemoptysis.

Conclusions

CT-guided core needle cutting biopsy of mediastinal nodes through a transpulmonary approach is a safe and efficient diagnostic method.

Key points

CT-guided core needle biopsy is an accurate technique for diagnosing mediastinal nodes.
The rates of complications are similar to those for pulmonary lesion biopsy.
Pneumothorax risk factors include distance from pleura to target lesion and number of visceral pleura.
Distance from pleura to target lesion is the risk factor for hemoptysis.
CT-guided core needle biopsy is an important diagnostic method for mediastinal nodes.
Literatur
1.
Zurück zum Zitat Louie BE, Kapur S, Farivar AS et al (2011) Safety and utility of mediastinoscopy in non-small cell lung cancer in a complex mediastinum. Ann Thorac Surg 92:278–282CrossRefPubMed Louie BE, Kapur S, Farivar AS et al (2011) Safety and utility of mediastinoscopy in non-small cell lung cancer in a complex mediastinum. Ann Thorac Surg 92:278–282CrossRefPubMed
2.
Zurück zum Zitat Kang HJ, Hwangbo B, Lee GK et al (2014) EBUS-centred versus EUScentred mediastinal staging in lung cancer: a randomized controlled trial. Thorax 69:261–268CrossRefPubMed Kang HJ, Hwangbo B, Lee GK et al (2014) EBUS-centred versus EUScentred mediastinal staging in lung cancer: a randomized controlled trial. Thorax 69:261–268CrossRefPubMed
3.
Zurück zum Zitat Micames CG, McCrory DC, Cavey DA, Jowell PS, Gress FG (2007) Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: A systematic review and metaanalysis. Chest 131:539–548CrossRefPubMed Micames CG, McCrory DC, Cavey DA, Jowell PS, Gress FG (2007) Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: A systematic review and metaanalysis. Chest 131:539–548CrossRefPubMed
4.
Zurück zum Zitat Yasufuku K, Pierre A, Darling G et al (2011) A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer. Thorac Cardiovasc Surg 142:1393–1400CrossRef Yasufuku K, Pierre A, Darling G et al (2011) A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer. Thorac Cardiovasc Surg 142:1393–1400CrossRef
5.
Zurück zum Zitat Adams K, Shah PL, Edmonds L, Lim E (2009) Test performance of endobronchial ultrasound and transbronchial needle aspiration biopsy for mediastinal staging in patients with lung cancer: Systematic review and meta-analysis. Thorax 64:757–762CrossRefPubMed Adams K, Shah PL, Edmonds L, Lim E (2009) Test performance of endobronchial ultrasound and transbronchial needle aspiration biopsy for mediastinal staging in patients with lung cancer: Systematic review and meta-analysis. Thorax 64:757–762CrossRefPubMed
6.
Zurück zum Zitat Gu P, Zhao YZ, Jiang LY et al (2009) Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: A systematic review and meta-analysis. Eur J Cancer 45:1389–1396CrossRefPubMed Gu P, Zhao YZ, Jiang LY et al (2009) Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: A systematic review and meta-analysis. Eur J Cancer 45:1389–1396CrossRefPubMed
7.
Zurück zum Zitat Detterbeck F, Puchalski J, Rubinowitz A, Cheng D (2010) Classification of the thoroughness of mediastinal staging of lung cancer. Chest 137:436–442CrossRefPubMed Detterbeck F, Puchalski J, Rubinowitz A, Cheng D (2010) Classification of the thoroughness of mediastinal staging of lung cancer. Chest 137:436–442CrossRefPubMed
8.
Zurück zum Zitat Szlubowski A, Zielinski M, Soja J et al (2010) A combined approach of endobronchial and endoscopic ultrasound-guided needle aspiration in the radiologically normal mediastinum in nonsmall-cell lung cancer staging—a prospective trial. Eur J Cardiothorac Surg 37:1175–1179CrossRefPubMed Szlubowski A, Zielinski M, Soja J et al (2010) A combined approach of endobronchial and endoscopic ultrasound-guided needle aspiration in the radiologically normal mediastinum in nonsmall-cell lung cancer staging—a prospective trial. Eur J Cardiothorac Surg 37:1175–1179CrossRefPubMed
9.
Zurück zum Zitat Hwangbo B, Lee GK, Lee HS et al (2010) Transbronchial and transesophageal fine-needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer. Chest 138:795–802CrossRefPubMed Hwangbo B, Lee GK, Lee HS et al (2010) Transbronchial and transesophageal fine-needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer. Chest 138:795–802CrossRefPubMed
10.
Zurück zum Zitat Gupta S, Seaberg K, Wallace MJ et al (2005) Imaging-guided percutaneous biopsy of mediastinal lesions: different approaches and anatomic considerations. RadioGraphics 25:763–788CrossRefPubMed Gupta S, Seaberg K, Wallace MJ et al (2005) Imaging-guided percutaneous biopsy of mediastinal lesions: different approaches and anatomic considerations. RadioGraphics 25:763–788CrossRefPubMed
11.
Zurück zum Zitat Priola AM, Priola SM, Cataldi A et al (2008) CT-guided percutaneous transthoracic biopsy in the diagnosis of mediastinal masses: evaluation of 73 procedures. Radiol Med 113:3–15CrossRefPubMed Priola AM, Priola SM, Cataldi A et al (2008) CT-guided percutaneous transthoracic biopsy in the diagnosis of mediastinal masses: evaluation of 73 procedures. Radiol Med 113:3–15CrossRefPubMed
12.
Zurück zum Zitat Virginia PD, Isabel TS, Francisco GR et al (2010) Usefulness CT-guided F.N.A.C. in the diagnosis of mediastinal lesions. Arch Bronconeumol 46:223–229 Virginia PD, Isabel TS, Francisco GR et al (2010) Usefulness CT-guided F.N.A.C. in the diagnosis of mediastinal lesions. Arch Bronconeumol 46:223–229
13.
Zurück zum Zitat Schmidt RL, Witt BL, Lopez-Calderon LE, Layfield LJ (2013) The influence of rapid onsite evaluation on the adequacy rate of fine-needle aspiration cytology. A systematic review and meta-analysis. Am J Clin Pathol 139:300–308CrossRefPubMed Schmidt RL, Witt BL, Lopez-Calderon LE, Layfield LJ (2013) The influence of rapid onsite evaluation on the adequacy rate of fine-needle aspiration cytology. A systematic review and meta-analysis. Am J Clin Pathol 139:300–308CrossRefPubMed
14.
Zurück zum Zitat Rusch VW, Asamura H, Watanabe H et al (2009) The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol 4:568–577CrossRefPubMed Rusch VW, Asamura H, Watanabe H et al (2009) The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol 4:568–577CrossRefPubMed
15.
Zurück zum Zitat O’Neill AC, McCarthy C, Ridge CA et al (2012) Rapid needle-out patient-rollover time after percutaneous CT-guided transthoracic biopsy of lung nodes: effect on pneumothorax rate. Radiology 262:314–319CrossRefPubMed O’Neill AC, McCarthy C, Ridge CA et al (2012) Rapid needle-out patient-rollover time after percutaneous CT-guided transthoracic biopsy of lung nodes: effect on pneumothorax rate. Radiology 262:314–319CrossRefPubMed
16.
Zurück zum Zitat Hosmer DW, Lemeshow S (2000) Assessing the fit of the model. In: Applied logistic regression, 2nd edn. Wiley, New York, NY, pp 143–202CrossRef Hosmer DW, Lemeshow S (2000) Assessing the fit of the model. In: Applied logistic regression, 2nd edn. Wiley, New York, NY, pp 143–202CrossRef
17.
Zurück zum Zitat Priola AM, Priola SM, Cataldi A et al (2007) Accuracy of CT-guided transthoracic needle biopsy of lung lesions: factors affecting diagnostic yield. Radiol Med 112:1142–1159CrossRefPubMed Priola AM, Priola SM, Cataldi A et al (2007) Accuracy of CT-guided transthoracic needle biopsy of lung lesions: factors affecting diagnostic yield. Radiol Med 112:1142–1159CrossRefPubMed
18.
Zurück zum Zitat Khan MF, Straub R, Moghaddam SR et al (2008) Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CTguided transthoracic biopsy. Eur Radiol 18:1356–1363CrossRefPubMed Khan MF, Straub R, Moghaddam SR et al (2008) Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CTguided transthoracic biopsy. Eur Radiol 18:1356–1363CrossRefPubMed
19.
Zurück zum Zitat Hiraki T, Mimura H, Gobara H et al (2009) CT fluoroscopy-guided biopsy of 1,000 pulmonary lesions performed with 20-gauge coaxial cutting needles: diagnostic yield and risk factors for diagnostic failure. Chest 136:1612–1617CrossRefPubMed Hiraki T, Mimura H, Gobara H et al (2009) CT fluoroscopy-guided biopsy of 1,000 pulmonary lesions performed with 20-gauge coaxial cutting needles: diagnostic yield and risk factors for diagnostic failure. Chest 136:1612–1617CrossRefPubMed
20.
Zurück zum Zitat Lee SM, Park CM, Lee KH et al (2014) C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodes: clinical experience in 1108 patients. Radiology 271:291–300CrossRefPubMed Lee SM, Park CM, Lee KH et al (2014) C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodes: clinical experience in 1108 patients. Radiology 271:291–300CrossRefPubMed
21.
Zurück zum Zitat Zhong-yuan YIN, Zhen-yu LIN, Ye WANG et al (2015) Risk Factors of Complications after CT-guided Percutaneous Needle Biopsy of Lumps Near Pulmonary Hilum. J Huazhong Univ Sci Technol 35:278–282CrossRef Zhong-yuan YIN, Zhen-yu LIN, Ye WANG et al (2015) Risk Factors of Complications after CT-guided Percutaneous Needle Biopsy of Lumps Near Pulmonary Hilum. J Huazhong Univ Sci Technol 35:278–282CrossRef
22.
Zurück zum Zitat Choi JW, Park CM, Goo JM et al (2012) C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of small (≤20 mm) lung nodes:diagnostic accuracy and complications in 161 patients. AJR Am J Roentgenol 199:W322–W330CrossRefPubMed Choi JW, Park CM, Goo JM et al (2012) C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of small (≤20 mm) lung nodes:diagnostic accuracy and complications in 161 patients. AJR Am J Roentgenol 199:W322–W330CrossRefPubMed
23.
Zurück zum Zitat Choo JY, Park CM, Lee NK et al (2013) Percutaneous transthoracic needle biopsy of small (≤1 cm) lung nodes under C-arm cone-beam CT virtual navigation guidance. Eur Radiol 23:712–719CrossRefPubMed Choo JY, Park CM, Lee NK et al (2013) Percutaneous transthoracic needle biopsy of small (≤1 cm) lung nodes under C-arm cone-beam CT virtual navigation guidance. Eur Radiol 23:712–719CrossRefPubMed
24.
Zurück zum Zitat Moreland A, Novogrodsky E, Brody L et al (2016) Pneumothorax with prolonged chest tube requirement after CT-guided percutaneous lung biopsy: incidence and risk factors. Eur Radiol. doi:10.1007/s00330-015-4200-7 PubMed Moreland A, Novogrodsky E, Brody L et al (2016) Pneumothorax with prolonged chest tube requirement after CT-guided percutaneous lung biopsy: incidence and risk factors. Eur Radiol. doi:10.​1007/​s00330-015-4200-7 PubMed
25.
Zurück zum Zitat Ko JP, Shepard JO, Drucker EA et al (2001) Factors influencing pneumothorax rate at lung biopsy: are dwell time and angle of pleural puncture contributing factors? Radiology 218:491–496CrossRefPubMed Ko JP, Shepard JO, Drucker EA et al (2001) Factors influencing pneumothorax rate at lung biopsy: are dwell time and angle of pleural puncture contributing factors? Radiology 218:491–496CrossRefPubMed
26.
Zurück zum Zitat Biswajit C, JohnE E, Rakesh P et al (2009) Risk assessment of pneumothorax and pulmonary haemorrhage complicating percutaneous co-axial cutting needle lung biopsy. Resp Med 103:449–455CrossRef Biswajit C, JohnE E, Rakesh P et al (2009) Risk assessment of pneumothorax and pulmonary haemorrhage complicating percutaneous co-axial cutting needle lung biopsy. Resp Med 103:449–455CrossRef
Metadaten
Titel
CT-guided core needle biopsy of mediastinal nodes through a transpulmonary approach: retrospective analysis of the procedures conducted over six years
verfasst von
Zhongyuan Yin
Zhiwen Liang
Pengcheng Li
Qiong Wang
Publikationsdatum
03.01.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
European Radiology / Ausgabe 8/2017
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-016-4718-3

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