Feasibility and accuracy of CT-guided percutaneous needle biopsy of cavitary pulmonary lesions

PURPOSEWe aimed to evaluate the feasibility, accuracy, and complications of computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) of cavitary lesions.METHODSConsecutive PTNB procedures in an academic institution over a 4-year period were reviewed, 53 of which were performed on patients with cavitary lesions. The demographic data of patients, lesion characteristics, biopsy technique and complications, initial pathologic results, and final diagnosis were reviewed. A final diagnosis was established through surgical correlation, microbiology or clinico-radiologic follow-up for at least 18 months after biopsy.RESULTSThe overall accuracy of PTNB was 81%. In 33 patients (62%) the cavitary lesion was found to be malignant (23 lung cancers and 10 metastases). The sensitivity and specificity for malignancy was 91% and 100%, respectively. In 20 patients (38%) a benign etiology was established (16 infections and 4 noninfectious etiologies), with PTNB demonstrating a sensitivity of 81% and specificity of 100% for infection. Wall thickness at the biopsy site, lesion in lower lobe, and malignancy were significant independent risk factors for diagnostic success. Minor complications occurred in 28% of cases: 13 pneumothoraces (5 requiring chest tube), 1 small hemothorax, and 1 mild hemoptysis. A nonsignificant higher chest tube insertion rate was seen in cavities with a thinner wall.CONCLUSIONPTNB of cavitary lesions provides high accuracy, sensitivity, and specificity for both malignancy and infection and has an acceptable complication rate. Wall thickness at the biopsy site, lesion in lower lobe, and malignancy were significant independent risk factors for diagnostic success. Samples for microbiology should be obtained in all patients, especially in the absence of on-site cytology, due to the high prevalence of infection in cavitary lesions

Clinicopathologic and Imaging Features of Non-Small-Cell Lung Cancer with MET Exon 14 Skipping Mutations

MET exon 14 (METex14) skipping mutations are an emerging potentially targetable oncogenic driver mutation in non-small-cell lung cancer (NSCLC). The imaging features and patterns of metastasis of NSCLC with primary METex14 skipping mutations (METex14-mutated NSCLC) are not well described. Our goal was to determine the clinicopathologic and imaging features that may suggest the presence of METex14 skipping mutations in NSCLC. This IRB-approved retrospective study included NSCLC patients with primary METex14 skipping mutations and pre-treatment imaging data between January 2013 and December 2018. The clinicopathologic characteristics were extracted from electronic medical records. The imaging features of the primary tumor and metastases were analyzed by two thoracic radiologists. In total, 84 patients with METex14-mutated NSCLC (mean age = 71.4 ± 10 years; F = 52, 61.9%, M = 32, 38.1%; smokers = 47, 56.0%, nonsmokers = 37, 44.0%) were included in the study. Most tumors were adenocarcinoma (72; 85.7%) and presented as masses (53/84; 63.1%) that were peripheral in location (62/84; 73.8%). More than one in five cancers were multifocal (19/84; 22.6%). Most patients with metastatic disease had only extrathoracic metastases (23/34; 67.6%). Fewer patients had both extrathoracic and intrathoracic metastases (10/34; 29.4%), and one patient had only intrathoracic metastases (1/34, 2.9%). The most common metastatic sites were the bones (14/34; 41.2%), the brain (7/34; 20.6%), and the adrenal glands (7/34; 20.6%). Four of the 34 patients (11.8%) had metastases only at a single site. METex14-mutated NSCLC has distinct clinicopathologic and radiologic features

MRI in detection of hepatocellular carcinoma (HCC)

Hepatocellular carcinoma (HCC) is the commonest malignancy of the liver and is usually due to cirrhosis. Early detection of HCC and the premalignant dysplastic nodules has implications on the management options of tumor ablation, liver resection and transplantation. Magnetic resonance imaging is useful for the detection and characterization of lesions, in the identification of dysplastic nodules and their malignant transformation into HCC

Case 40-2010 — A 68-Year-Old Woman with Chest Pain during an Airplane Flight

A 68-year-old woman was transferred to this hospital because of substernal chest pain. An ECG showed evidence of MI. Coronary angiography was performed, with stenting of an occluded coronary artery. On the fourth hospital day, hypotension, bradycardia, and cardiac arrest occurred, and the patient died

Multifactorial Analysis of Mortality in Screening Detected Lung Cancer

We hypothesized that severity of coronary artery calcification (CAC), emphysema, muscle mass, and fat attenuation can help predict mortality in patients with lung cancer participating in the National Lung Screening Trial (NLST). Following regulatory approval from the Cancer Data Access System (CDAS), all patients diagnosed with lung cancer at the time of the screening study were identified. These subjects were classified into two groups: survivors and nonsurvivors at the conclusion of the NLST trial. These groups were matched based on their age, gender, body mass index (BMI), smoking history, lung cancer stage, and survival time. CAC, emphysema, muscle mass, and subcutaneous fat attenuation were quantified on baseline low-dose chest CT (LDCT) for all patients in both groups. Nonsurvivor group had significantly greater CAC, decreased muscle mass, and higher fat attenuation compared to the survivor group (p<0.01). No significant difference in severity of emphysema was noted between the two groups (p>0.1). We thus conclude that it is possible to create a quantitative prediction model for lung cancer mortality for subjects with lung cancer detected on screening low-dose CT (LDCT)

Radiation dose reduction in chest dual-energy computed tomography: effect on image quality and diagnostic information

Abstract Objective: To determine whether dual-energy computed tomography (DECT) of the chest can be performed at a reduced radiation dose, with an emphasis on images generated with post-processing techniques. Materials and Methods: In 21 patients undergoing DECT of the chest in a dual-source scanner, an additional image series was acquired at a reduced radiation dose. Four thoracic radiologists assessed both image series for image quality, normal thoracic structures, as well as pulmonary and mediastinal abnormalities, on virtual monochromatic images at 40 keV and 60 keV. Data were analyzed with Student's t-test, kappa statistics, analysis of variance, and the Wilcoxon signed-rank test. Results: The overall image quality of 60 keV virtual monochromatic images at a reduced radiation dose was considered optimal in all patients, and no abnormalities were missed. Contrast enhancement and lesion detection performance were comparable between reduced-dose images at 40 keV and standard-of-care images at 60 keV. The intraobserver and interobserver agreement were both good. The mean volumetric CT dose index (CTDIvol), size-specific dose estimate (SSDE), dose-length product (DLP), and effective dose (ED) for reduced-dose DECT were 3.0 ± 0.6 mGy, 4.0 ± 0.6 mGy, 107 ± 30 mGy.cm, and 1.5 ± 0.4 mSv, respectively. Conclusion: DECT of the chest can be performed at a reduced radiation dose (CTDIvol < 3 mGy) without loss of diagnostic information

Clinical role, safety and diagnostic accuracy of percutaneous transthoracic needle biopsy in the evaluation of pulmonary consolidation

Abstract Background To determine the clinical role, safety, and diagnostic accuracy of percutaneous transthoracic needle biopsy in the evaluation of pulmonary consolidation. Methods A retrospective review of all computed tomography (CT)-guided percutaneous transthoracic needle biopsies (PTNB) at a tertiary care hospital over a 4-year period was performed to identify all cases of PTNB performed for pulmonary consolidation. For each case, CT Chest images were reviewed by two thoracic radiologists. Histopathologic and microbiologic results were obtained and clinical follow-up was performed. Results Thirty of 1090 (M:F 17:30, mean age 67 years) patients underwent PTNB for pulmonary consolidation (2.8% of all biopsies). A final diagnosis was confirmed in 29 patients through surgical resection, microbiology, or clinicoradiologic follow-up for at least 18 months after biopsy. PTNB had an overall diagnostic accuracy of 83%. A final diagnosis of malignancy was made in 20/29 patients, of which 19 were correctly diagnosed by PTNB, resulting in a sensitivity of 95% and specificity of 100% for malignancy. In all cases of primary lung cancer, adequate tissue for molecular testing was obtained. A benign final diagnosis was made in 9 patients, infection in 5 cases and non-infectious benign etiology in 4 cases. PTNB correctly diagnosed all cases of infection. Minor complications occurred in 13% (4/30) of patients. Conclusions Pulmonary consolidation can be safely evaluated with CT-guided percutaneous needle biopsy. Diagnostic yield is high, especially for malignancy. PTNB of pulmonary consolidation should be considered following non-diagnostic bronchoscopy