Biópsia de lesões pulmonares por agulha cortante guiada pela tomografia computadorizada

PURPOSE: To report the experience of a radiology department in the use of computed tomography - guided cutting needle biopsy of pulmonary nodules, by evaluating diagnostic yield and incidence of complications. METHODS: This is a retrospective analysis of 52 consecutive patients who underwent lung lesion biopsy guided by computed tomography, performed between May 1997 and May 2000. Thirty-five patients were male and 17 were female, with ages ranging from 5 to 85 years (median, 62 years). The size of the lesions ranged from 1.8 to 15 cm (median, 5.4 cm). RESULTS: In a total of 52 biopsies of lung lesions, 51 biopsies (98.1%) supplied appropriate material for histopathological diagnosis, with 9 diagnosed (17.3%) as benign and 42 (80.8%) as malignant lesions. Specific diagnosis was obtained in 44 (84.6%) biopsies: 4 benign (9.1%) and 40 (90.9%) malignant lesions. The sensitivity, specificity, and accuracy of the cutting needle biopsies for determining presence of malignancy were 96.8%, 100%, and 97.2%, respectively. Complications occurred in 9 cases (17.3%), including 6 cases (11.5%) of small pneumothorax, 1 (1.9%) of hemoptysis, 1 (1.9%) of pulmonary hematoma, and 1 (1.9%) of thoracic wall hematoma. All had spontaneous resolution. There were no complications requiring subsequent intervention. CONCLUSION: The high sensitivity and specificity of the method and the low rate of complications have established cutting needle biopsy as an efficient and safe tool for the diagnosis of lung lesions. In our hospital, cutting needle biopsy is considered a reliable procedure for the evaluation of indeterminate pulmonary nodules.OBJETIVO: Apresentar a experiência inicial de um serviço de radiologia, no uso de biópsia de lesões pulmonares por agulha cortante guiada por tomografia computadorizada, avaliando o valor diagnóstico e incidência de complicações. MÉTODOS: Realizamos análise retrospectiva de 52 pacientes submetidos à biópsia de lesão pulmonar guiada pela tomografia computadorizada. Analisamos o período de maio de 1997 até maio de 2000. Trinta e cinco pacientes eram de sexo masculino e 17 feminino, com idade variando de cinco a 85 anos (mediana de 62 anos). O tamanho das lesões pulmonares variou de 1,8 a 15 cm (mediana de 5,4 cm). RESULTADOS: Entre os 52 casos, 51 (98,1%) forneceram material adequado para diagnóstico histopatológico, com nove diagnósticos (17,3%) de lesão benigna e 42 (80,8%) de lesão maligna. Quarenta e quatro (84,6%) obtiveram diagnósticos específicos a partir de análise histopatológica, sendo quatro benignos e 40 malignos. A sensibilidade, a especificidade e a acurácia do método para lesões malignas foi de 96,8%, 100% e 97,2%, respectivamente. Nove casos (17,3%) de complicações ocorreram, sendo seis casos (11,5%) de pneumotórax pequeno, um (1,9%) de hemoptise, um (1,9%) de hematoma intrapulmonar e um outro caso (1,9%) de hematoma na parede torácica. Não houve complicação que necessitasse de intervenção posterior. CONCLUSÃO: As altas sensibilidade e especificidade, e o baixo índice de complicações tornam o método de biópsia por agulhas cortantes uma ferramenta eficiente e segura para diagnóstico de lesões pulmonares. Em nosso hospital é considerado um procedimento confiável para a avaliação de nódulos pulmonares indeterminados

Predictive success factors for ct-guided fine needle aspiration biopsy of pulmonary lesions

OBJECTIVE: Computed tomography-guided percutaneous fine needle aspiration biopsy of lung lesions is a simple, safe and reproducible procedure. Currently, it is widely used to diagnose lung lesions. However, different factors can influence the success rates of this procedure. The purpose of this study was to determine the influence of radiological and procedural characteristics in predicting the success rates of computed tomography-guided fine needle aspiration biopsy of lung lesions. SUBJECTS AND METHODS: A retrospective study was developed and involved 340 patients who were submitted to a consecutive series of 362 computed tomography-guided fine needle aspiration biopsies of lung lesions, between July 1996 and June 2004, using 22-gauge needles (Chiba). Variables such as the radiological characteristics of the lesions, secondary pulmonary radiological findings, and procedural techniques were studied. RESULTS: For this study, 304 (84%) fine needle aspiration biopsies of lung lesions provided sufficient material for cytological evaluation. The variables that predicted sufficient material for cytological evaluation were lesions larger than 40 mm (p=0.02), lesions on the superior lung lobes (p=0.02), and suspicion of primary lung malignancy (p=0.03). From the multivariate analysis, the only predictive variable for success of the biopsies was localization on the superior lobes (p=0.01). CONCLUSIONS: Computed tomography-guided percutaneous fine needle aspiration biopsy of lung lesions showed greater rates of success in biopsies performed in patients with suspicion of primary lung malignancy, with lesions located in the superior lobes, and that have diameters equal to and larger than 40 mm

Biópsia de massas mediastinais guiadas por tomografia computadorizada: agulhas finas versus cortantes

PURPOSE: To report the experience of a radiology department in the use of computed tomography guided biopsies of mediastinal lesions with fine and cutting needles, describing the differences between them. The results of adequacy of the sample and histologic diagnoses are presented according to the type of needle used. METHODS: We present a retrospective study of mediastinal biopsies guided by computed tomography performed from January 1993 to December 1999. Eighty-six patients underwent mediastinal biopsy in this period, 37 with cutting needles, 38 with fine needles, and 11 with both types (total of 97 biopsies). RESULTS: In most cases, it was possible to obtain an adequate sample (82.5%) and specific diagnosis (67.0%). Cutting-needle biopsy produced a higher percentage of adequate samples (89.6% versus 75.5%, P = 0.068) and of specific diagnosis (81.3% versus 53.1%, P = 0.003) than fine-needle biopsy. There were no complications that required intervention in either group. CONCLUSION: Because they are practical, safe, and can provide accurate diagnoses, image-guided biopsies should be considered the procedure of choice in the initial exploration of patients with mediastinal masses. In our experience, cutting needles gave higher quality samples and diagnostic rates. We recommend the use of cutting needles as the preferred procedure.OBJETIVO: Apresentar a experiência de um serviço de radiologia na prática de punções biópsias de massas mediastinais guiadas por tomografia computadorizada com agulhas finas ou cortantes, descrevendo as diferenças entre elas. Os resultados referentes a material suficiente e diagnóstico histológico são apresentados de acordo com o tipo de agulha utilizado. MÉTODOS: Apresentamos um estudo retrospectivo de biópsias mediastinais guiadas por tomografia computadorizada realizadas em nosso hospital no período de janeiro de 1993 a dezembro de 1999. Oitenta e seis pacientes foram submetidos a biópsia mediastinal neste período, sendo 37 realizadas com agulhas cortantes, 38 com agulhas finas e 11 com ambas, (total de 97 biópsias). RESULTADOS: Na maioria dos casos foi possível se obter material adequado (82.5% ) e diagnóstico específico (67 %). As agulhas cortantes apresentaram maior porcentagem de material suficiente (89.6% versus 75,5%, P=0,068) e de diagnóstico específico (81,3% versus 53,1%, p=0,003 ) do que as agulhas finas. Não houveram complicações que requisessem intervenção em nenhum dos grupos. CONCLUSÃO: Pela praticidade, segurança e grande probabilidade de diagnóstico acurado sem procedimentos mais invasivos, as biópsias guiadas por imagem devem ser consideradas como a primeira etapa na investigação de massas mediastinais. Pela nossa experiência as agulhas cortantes fornecem material de maior qualidade e maior taxa de diagnóstico. Nós recomendamos o uso das agulhas cortantes como procedimento preferencial

CT-guided biopsy of lung lesions: defining the best needle option for a specific diagnosis

OBJECTIVES: To evaluate the performance of fine and cutting needles in computed tomography guided-biopsy of lung lesions suspicious for malignancy and to determine which technique is the best option for a specific diagnosis. METHODS: This retrospective study reviewed the data from 362 (71.6%) patients who underwent fine-needle aspiration biopsy and from 97 (19.7%) patients who underwent cutting-needle biopsy between January 2006 and December 2011. The data concerning demographic and lesion characteristics, procedures, biopsy sample adequacy, specific diagnoses, and complications were collected. The success and complication rates of both biopsy techniques were calculated. RESULTS: Cutting-needle biopsy yielded significantly higher percentages of adequate biopsy samples and specific diagnoses than did fine-needle aspiration biopsy (

Diffuse bronchiolitis pattern on a computed tomography scan as a presentation of pulmonary tumor thrombotic microangiopathy: a case report

<p>Abstract</p> <p>Introduction</p> <p>Pulmonary tumor thrombotic microangiopathy is a rare complication of malignant diseases. The diagnosis is extremely difficult and is most often performed after death. Invariably, patients develop acute pulmonary hypertension causing right heart failure, shortness of breath and death in a few days. We describe the clinical and radiological findings of a patient who presented with this complication.</p> <p>Case presentation</p> <p>A 28-year-old Caucasian woman with a previous history of pelvic tumor resection two months previously, suggestive of metastatic adenocarcinoma, presented with intense shortness of breath. A computed tomography scan showed signs of acute cor pulmonale and diffuse nodular opacities associated with a tree-in-bud pattern disseminated through her lungs, suggestive of bronchiolitis. Our patient's condition worsened and she underwent a surgical biopsy. Pathologic analysis of the biopsied specimens revealed pulmonary tumor thrombotic microangiopathy. Our patient's tumor evolved from a gastric origin (Krukenberg tumor). She underwent progressive clinical deterioration and died less than 24 hours after the biopsy. None of the cases described previously in the literature had diffuse centrilobular nodular opacities associated with a tree-in-bud pattern disseminated through the lungs, as in our case.</p> <p>Conclusion</p> <p>Pulmonary tumor thrombotic microangiopathy should be considered in cancer patients with rapidly progressing dyspnea, chest computed tomography findings compatible with pulmonary hypertension and typical findings of inflammatory bronchiolitis.</p

Predictive complication factors for ct‐guided fine needle aspiration biopsy of pulmonary lesions

OBJECTIVE: Distinct aspects can influence the complication rates of computed tomography-guided percutaneous fine needle aspiration biopsy of lung lesions. The purpose of the current study is to determine the influence of radiological techniques and clinical characteristics in predicting complications from this procedure. SUBJECTS AND METHODS: A retrospective study was developed involving 340 patients who were submitted to a consecutive series of 362 computed tomography-guided fine needle aspiration biopsies of lung lesions between July 1996 and June 2004, using 22-gauge needles (CHIBA). Variables such as the radiological characteristics of the lesions, secondary pulmonary radiological findings, co-morbidities, and aspects concerning the procedure were studied. RESULTS: The diameters of the lung lesions varied from 9 to 140 mm, with a mean of 51.5 ± 24.3 mm and median of 40mm. The depth of the lesions varied from 10 mm to 130 mm, with a mean of 44 ± 20.9mm, and median median of 52 mm. Complications occurred in 52 (14.4%) cases, pneumothorax being the most frequent, with 40 (11.1%) cases, followed by hemoptisis with 7 (1.9%) cases, and hematoma with 4 (1.1%) cases. Lesions that did not contact the pleura, with normal pulmonary tissue interposition between lesion and pleura, had higher complication rates, with 22 (22%) cases, than lesions that contact the pleura, with 6 (9%) cases, with a statistically significant difference (p = 0.03). CONCLUSIONS: CT-guided percutaneous fine needle aspiration biopsy of lung lesions had a lower rate of complications in our study and presented more rates of complications on lesions that lack pleural contact

Predictive complication factors for ct-guided fine needle aspiration biopsy of pulmonary lesions

OBJECTIVE: Distinct aspects can influence the complication rates of computed tomography-guided percutaneous fine needle aspiration biopsy of lung lesions. The purpose of the current study is to determine the influence of radiological techniques and clinical characteristics in predicting complications from this procedure. SUBJECTS AND METHODS: A retrospective study was developed involving 340 patients who were submitted to a consecutive series of 362 computed tomography-guided fine needle aspiration biopsies of lung lesions between July 1996 and June 2004, using 22-gauge needles (CHIBA). Variables such as the radiological characteristics of the lesions, secondary pulmonary radiological findings, co-morbidities, and aspects concerning the procedure were studied. RESULTS: The diameters of the lung lesions varied from 9 to 140 mm, with a mean of 51.5 ± 24.3 mm and median of 40mm. The depth of the lesions varied from 10 mm to 130 mm, with a mean of 44 ± 20.9mm, and median median of 52 mm. Complications occurred in 52 (14.4%) cases, pneumothorax being the most frequent, with 40 (11.1%) cases, followed by hemoptisis with 7 (1.9%) cases, and hematoma with 4 (1.1%) cases. Lesions that did not contact the pleura, with normal pulmonary tissue interposition between lesion and pleura, had higher complication rates, with 22 (22%) cases, than lesions that contact the pleura, with 6 (9%) cases, with a statistically significant difference (p = 0.03). CONCLUSIONS: CT-guided percutaneous fine needle aspiration biopsy of lung lesions had a lower rate of complications in our study and presented more rates of complications on lesions that lack pleural contact

New Applications of Radioguided Surgery in Oncology

OBJECTIVE: To report oncological cases (excluding those related to breast cancer) for which radioguided surgery has been used in combination with the Radioguided Occult Lesion Localization technique. INTRODUCTION: Radioguided surgery enables a surgeon to identify lesions or tissues that have been preoperatively marked with radioactive substances. The Radioguided Occult Lesion Localization technique has been widely used to identify the sentinel lymph node and occult lesions in patients with breast cancer. However, few studies have reported the use of this technique for non-breast cancer pathologies. METHODOLOGY: In all cases, injection of Technecium-99m sulfur colloid was performed, directly inside or near by the suspicious lesion, guided by ultrasound or computed tomography, up to 36 hours prior to the surgical procedure. Intraoperative lesion detection was carried out using a gamma-probe. RESULTS: We report five oncology cases in which preoperative markings of the lesions were carried out using the Radioguided Occult Lesion Localization technique. The patients presented with the following: recurrence of renal cell carcinoma, cervical recurrence of papillary carcinoma of the thyroid, recurrence of retroperitoneal sarcoma, lesions of the popliteal fossa, and recurrence of rhabdomyosarcoma of a thigh. In each case, the lesions that were marked preoperatively were ultimately successfully excised. CONCLUSIONS: Radioguided surgery has proven to be a safe and effective alternative for the management of oncology patients. The Radioguided Occult Lesion Localization technique can be useful in selected cases where suspect lesions may be difficult to identify intraoperatively, due to their dimensions or anatomical location. The procedure allows for more conservative excisions and reduces the surgery-related morbidity

Chest CT accuracy in the diagnosis of SARS-CoV-2 infection: initial experience in a cancer center

Objective: To evaluate the accuracy of chest computed tomography (CT) in patients with suspected severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) infection at a cancer center. Materials and Methods: This retrospective single-center study selected 91 patients who had chest CT and real-time polymerase chain reaction (RT-PCR) test collected at the same day. CT results were classified in negative, typical, indeterminate or atypical findings. Diagnostic accuracy, sensitivity and specificity were calculated for two different scenarios: in the first, only typical findings on CT were considered positive; in the second, both typical and indeterminate findings were considered positive. Results: Mean patients’ age was 58.2 years, most were male (60.4%) and had prior diagnosis of cancer (85.7%). CT showed typical findings in 28.6%, indeterminate findings in 24.2% and atypical findings in 26.4%. RT-PCR results were positive for SARS-CoV-2 in 27.5%. The sensitivity, specificity and accuracy in the first and second scenarios were respectively 64.0%, 84.8% and 79.1%, and 92.0%, 62.1% and 70.3%. Conclusion: CT has a high accuracy for the diagnosis of SARS-CoV-2 infection. Different interpretation criteria can provide either high sensitivity or high specificity. CT should be integrated as a triage test in resource-constrained environments during the pandemic to assist in the optimization of PCR-tests, isolation beds and intensive care units.Objetivo: Avaliar a acurácia da tomografia computadorizada (TC) de tórax em pacientes com suspeita de infecção por SARS-CoV-2 em um centro oncológico. Materiais e Métodos: Estudo retrospectivo e unicêntrico que selecionou 91 pacientes que realizaram TC de tórax e teste RT-PCR no mesmo dia. Os resultados da TC foram classificados em negativos, achados típicos, indeterminados ou atípicos. Acurácia diagnóstica, sensibilidade e especificidade foram calculadas para dois cenários: no primeiro, apenas TC com achados típicos foi considerada positiva; no segundo, achados típicos ou indeterminados foram considerados positivos. Resultados: A média de idade dos pacientes foi de 58,2 anos, sendo a maioria homens (60,4%) e com história de câncer prévio (85,7%). TC demonstrou achados típicos em 28,6%, indeterminados em 24,2% e atípicos em 26,4%. Resultados da RT-PCR foram positivos para SARS-CoV-2 em 27,5%. Sensibilidade, especificidade e acurácia no primeiro e segundo cenários foram, respectivamente, de 64,0%, 84,8% e 79,1%, e 92,0%, 62,1% e 70,3%. Conclusão: A TC tem alta acurácia para o diagnóstico de infecção por SARS-CoV-2. Diferentes critérios de interpretação fornecem maior sensibilidade ou especificidade. A TC deve ser integrada como um teste de triagem em ambientes com recursos limitados durante a pandemia, para ajudar na otimização da utilização de testes de PCR, leitos de isolamento e unidades de terapia intensiva

Facoemulsificação e implante de lente intraocular acrílica dobrável em crianças com retinoblastoma

PURPOSE: To study the results of cataract surgery in children with radiation-induced cataract after treatment for retinoblastoma. METHODS: Retrospective interventional case series. Six consecutive patients diagnosed with secondary cataracts due to radiation therapy for retinoblastoma. Intervention: Phacoemulsification and foldable acrylic intraocular lens implantation. Outcomes measu- red: Visual acuity, binocular indirect ophthalmoscopy and slit-lamp biomicroscopy. Aspirated lens material and aqueous humor samples were collected during surgery. RESULTS: Six uniocular children between 3 to 5 years of age at time of surgery were studied. The mean time interval between radiotherapy and cataract diagnosis was 22.3 months. The mean follow-up after surgery was 17.2 months (range: 12 to 23 months). All eyes achieved a clear visual axis after surgery allowing monitoring of the tumor status. None developed recurrence or retinoblastoma dissemination. Histopathological analysis of the aspired material showed no tumoral cells in all samples. All patients improved vision after cataract surgery. CONCLUSIONS: Phacoemulsification with acrylic intraocular lens implantation seems to be a safe, feasible, and effective method for the removal of radiation-induced cataracts in patients with treated retinoblastoma.OBJETIVOS: Estudar os resultados da cirurgia da catarata induzida pela radioterapia para o tratamento do retinoblastoma em crianças. MÉTODOS: Estudo retrospectivo intervencional em série de casos onde seis pacientes consecutivos apresentaram catarata secundária à terapia por radiação para o retinoblastoma. Intervenção: Facoemulsificação e implante de lente intraocular acrílica dobrável. Foram avaliadas: acuidade visual, oftalmoscopia binocular indireta e biomicroscopia. Material para análise histológica do cristalino e do humor aquoso foi coletado durante as cirurgias. RESULTADOS: Seis crianças, entre 3 e 5 anos de idade, com catarata secundária à radiação para tratamento de retinoblastoma foram submetidas à cirurgia de facoemulsificação com implante de lente intraocular. A média do intervalo de tempo decorrido entre a radioterapia e o diagnóstico da catarata foi 22,3 meses. O período médio de seguimento após a cirurgia foi de 17,2 meses (intervalo: 12 a 23 meses). Todos os olhos melhoraram a visão e mantiveram eixo visual livre permitindo a fundoscopia para monitorar o tumor. Nenhum paciente evoluiu com recorrência ou disseminação do retinoblastoma. A análise histopatológica do material colhido resultou em ausência de células tumorais nas amostras. CONCLUSÕES: A cirurgia de facoemulsificação com implante de lente intraocular acrílica dobrável mostrou ser um procedimento seguro e efetivo para o tratamento da catarata induzida pela radioterapia em pacientes portadores de retinoblastoma.Universidade Federal de São Paulo (UNIFESP) Department of OphthalmologyHospital A C Camargo Ocular Oncology DepartmentUniversidade Federal do Rio Grande do Sul Department of OphthalmologyUNIFESP, Department of OphthalmologySciEL