Öz
Aim: Imaging-guided transthoracic biopsy procedures are preferred by clinicians as they can be performed under local anesthesia and have a low complication risk. In our study, we aimed to
investigate the technical and diagnostic success rates of percutaneous lung biopsies performed under the guidance of computerized tomography (CT) and ultrasonography (US), complications, and possible reasons for increasing the complication rates and compare the results with the studies in the literature.
Materials and Methods: Eighty-seven patients underwent US-guided, and 31 patients underwent CTguided percutaneous lung biopsy. The files and radiological images of these patients were scanned retrospectively. The size and location of the lesions, the trans-parenchymal distance crossed during the procedure, needle type, complications, histopathological results, procedure times, and procedure costs were noted.
Results: Diagnostic success rates in US and CT guided biopsies were calculated as 91.9% and 77.4%, respectively. No complications developed in 85 of 87 patients who underwent US-guided fine
needle (FNAB) (n:33) and cutting needle biopsy (Tru-Cut) (n:54). Pneumothorax was observed in one patient and hemothorax was observed in one patient. Pneumothorax was found in 14 of the patients who underwent CT-guided biopsy, and parenchymal hemorrhage was found in 2 of them. A specific diagnosis could be made for 104 (88.1%) lesions. Significantly lower complication rates were found in US-guided procedures compared to CT-guided biopsy procedures (p<0.001). No correlation was
found between the development of complications and the demographic characteristics of the patients, lesion size, localization, and trans-parenchymal distance (p>0.05). Complications were found to be lower in pleural-based lesions compared to parenchymal lesions (p<0.001).
Conclusion: US and CT-guided needle biopsies of lung lesions are procedures with high technical and diagnostic success and low major complication rates. In case of appropriate lesion localization, US-guided biopsy procedures have high diagnostic success, low complication risk, shorter duration and lower cost compared to CT-guided biopsy procedures.
Anahtar Kelimeler
Lung cancer transthoracic biopsy ultrasonography computed tomography
Kaynakça
- Gupta S, Madoff DC. Image-Guided Percutaneous Needle Biopsy in Cancer Diagnosis and Staging. Tech Vasc Interv Radiol. 2007; 10 (2): 88–101.
- Tsai IC, Tsai WL, Chen MC et al. CT-guided core biopsy of lung lesions: A primer. AJR Am J Roentgenol. 2009; 193: 1228–35.
- Rossi UG, Seitun S, Ferro C. MDCT-guided transthoracic needle aspiration biopsy of the lung using the transscapular approach. CardioVasc Intervent Radiol. 2011; 34(1):184–7.
- Lee MH, Lubner MG, Hinshaw JL et al. Ultrasound guidance versus CT guidance for peripheral lung biopsy: Performance according to lesion size and pleural contact. AJR Am J Roentgenol. 2018; 210 (3), W110–7.
- di Bardino DM, Yarmus LB, Semaan RW. Transthoracic needle biopsy of the lung. J Thoracic Dis. 2015; 7(Suppl 4): 304–16.
- 6. Sconfienza LM, Mauri G, Grossi F et al. Pleural and peripheral lung lesions: Comparison of US- and CTguided biopsy. Radiology. 2013; 266 (3): 930–5.
- Sartori S. Emerging roles for transthoracic ultrasonography in pleuropulmonary pathology. World J Radiol. 2010; 2 (2): 83.
- Yao X, Gomes MM, Tsao MS et al. Fine-needle aspiration biopsy versus core-needle biopsy in diagnosing lung cancer: A systematic review. Curr Oncol. 2012; 19 (1): 16–27.
- Winokur RS, Pua BB, Sullivan B et al. Percutaneous lung biopsy: Technique, efficacy, and complications. Semin Intervent Radiol. 2013; 30 (2): 121–7.
- Heerink WJ, de Bock GH, de Jonge GJ et al. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol. 2017; 27 (1): 138–48.
- Huang W, Ye J, Qiu Y et al. Ultrasound-Guided Percutaneous Core Needle Biopsy of Peripheral Pulmonary Nodules ≤ 2 cm: Diagnostic Performance, Safety and Influence Factors. Front Oncol. 2021; 11, 1584.
- Sheth S, Hamper UM, Stanley DB et al. Ultrasonography US Guidance for Thoracic Biopsy: A Valuable Alternative to CT. Radiology. 1999; 210 (3), 721-6.
- Anzidei M, Porfiri A, Andrani F et al. Imaging-guided chest biopsies: techniques and clinical results. Insights into imaging, 2017; 8 (4), 419-28.
- Guo YQ, Liao XH, Li ZX et al. Ultrasound-Guided Percutaneous Needle Biopsy for Peripheral Pulmonary Lesions: Diagnostic Accuracy and Influencing Factors. Ultrasound Med Biol. 2018; 44 (5): 1003–11.
- Yamamoto N, Watanabe T, Yamada K et al. Efficacy and safety of ultrasound (US) guided percutaneous needle biopsy for peripheral lung or pleural lesion: Comparison with computed tomography (CT) guided needle biopsy. J Thorac Dis. 2019; 11 (3): 936–43.
- Portela-Oliveira E, Souza CA, Gupta A et al. Ultrasound-guided percutaneous biopsy of thoracic lesions: high diagnostic yield and low complication rate. Clin Radiol. 2021; 76 (4): 281–6.
- Laurent F, Latrabe V, Vergier B et al. CT-guided transthoracic needle biopsy of pulmonary nodules smaller than 20 mm: Results with an automated 20-gauge coaxial cutting needle. Clin Radiol. 2000; 55 (4): 281–7.
- Guimarães MD, Marchiori E, Hochhegger B et al. CT-guided biopsy of lung lesions: Defining the best needle option for a specific diagnosis. Clinics. 2014; 69 (5): 335–40.
- Huang M de, Weng HH, Hsu SL et al. Accuracy and complications of CT-guided pulmonary core biopsy in small nodules: A single-center experience. Cancer Imaging. 2019; 19 (1): 1–10.
- Mills M, Choi J, El-Haddad G et al. Retrospective analysis of technical success rate and procedure-related complications of 867 percutaneous CT-guided needle biopsies of lung lesions. Clin Radiol. 2017; 72(12):1038–46.
- Tae JK, Lee JH, Lee CT et al. Diagnostic accuracy of CT-guided core biopsy of ground-glass opacity pulmonary lesions. AJR Am J Roentgenol. 2008; 190(1):234–9.
- Sartori S, Tombesi P, Trevisani L et al. Accuracy of transthoracic sonography in detection of pneumothorax after sonographically guided lung biopsy: Prospective comparison with chest radiography. AJR Am J Roentgenol. 2007; 188 (1): 37–41.
- Yeow KM, Su IH, Pan KT et al. Risk factors of pneumothorax and bleeding: Multivariate analysis of 660 CTguided coaxial cutting needle lung biopsies. Chest. 2004; 126(3):748–54.
- Guo YQ, Liao XH, Li ZX et al. Ultrasound-guided percutaneous needle biopsy for peripheral pulmonary lesions: diagnostic accuracy and influencing factors. Ultrasound Med Biol. 2018; 44.5: 1003-11.
- Nair A, Anirudh S, Moorthy S et al. CT-guided lung fine needle aspiration biopsy: Analysis of efficacy, yield and intricacies. Indian J Med and Paediatr Oncol. 2018; 39 (2): 178–83.
Öz
Amaç: Görüntüleme rehberliğinde yapılan transtorasik biyopsi işlemleri, lokal anestezi ile yapılabilmesi ve düşük komplikasyon riski nedeni ile klinisyenler tarafından tercih edilmektedir.
Çalışmamızda bilgisayarlı tomografi (BT) ve ultrasonografi (US) rehberliğinde yapılan perkütan akciğer biyopsilerinin teknik ve tanısal başarı oranlarını, komplikasyonlarını ve komplikasyonu arttıran olası sebepleri araştırmayı ve literatürdeki çalışmalar ile karşılaştırmayı amaçladık.
Gereç ve Yöntem: Seksenyedi hastaya US, 31 hastaya BT rehberliğinde perkütan akciğer biyopsisi yapılmış olup bu hastaların dosyaları ve radyolojik görüntüleri retrospektif olarak taranmıştır.
Lezyonların boyutu, yerleşimi ve işlem sırasında geçilen transparankimal mesafe, iğne tipi, gelişen komplikasyonlar, histopatolojik sonuçlar, işlem süreleri ve maliyetleri not edilmiştir.
Bulgular: US ve BT rehberliğinde yapılan biyopsilerde tanısal başarı oranları sırası ile %91,9 ve %77,4 olarak hesaplanmıştır. US rehberliğinde ince iğne biyopsisi (İİAB) (n:33) ve kesici iğne biyopsisi (Tru-Cut) (n:54) yapılan 87 hastanın 85’inde komplikasyon gelişmemiştir. Bir hastada pnömotoraks, 1 hastada hematoraks gözlenmiştir. BT rehberliğinde biyopsi yapılan hastaların 14’ünde pnömotoraks, 2’ sinde parankimal kanama saptanmıştır. Yüz dört (%88,1) lezyona spesifik tanı koyulabilmiştir. US rehberliğinde yapılan biyopsi işlemlerinde, BT rehberliğinde yapılan işlemlere göre belirgin olarak düşük komplikasyon oranları saptanmıştır (p<0,001). Komplikasyon gelişimi ile hastaların demografik özellikleri, lezyon boyutu, lokalizasyonu transparankimal mesafe arasında korelasyon saptanmamıştır(p>0,05). Plevral tabanlı lezyonlarda, parankimal yerleşimli lezyonlara göre komplikasyon gelişme olasılığı daha düşük bulunmuştur (p<0,001).
Sonuç: Akciğer lezyonlarının US ve BT rehberliğinde iğne biyopsileri teknik ve tanısal başarısı yüksek, majör komplikasyon oranı düşük işlemlerdir. Uygun lezyon yerleşimi durumunda US rehberliğinde yapılan biyopsi işlemleri tanısal başarısı yüksek, komplikasyon riski düşük, BT rehberliğinde yapılan biyopsi işlemlerine göre daha kısa süreli ve düşük maliyetli uygulamalardır.
Anahtar Kelimeler
Akciğer kanser transtorasik biyopsi ultrasonografi bilgisayarlı tomografi
Kaynakça
- Gupta S, Madoff DC. Image-Guided Percutaneous Needle Biopsy in Cancer Diagnosis and Staging. Tech Vasc Interv Radiol. 2007; 10 (2): 88–101.
- Tsai IC, Tsai WL, Chen MC et al. CT-guided core biopsy of lung lesions: A primer. AJR Am J Roentgenol. 2009; 193: 1228–35.
- Rossi UG, Seitun S, Ferro C. MDCT-guided transthoracic needle aspiration biopsy of the lung using the transscapular approach. CardioVasc Intervent Radiol. 2011; 34(1):184–7.
- Lee MH, Lubner MG, Hinshaw JL et al. Ultrasound guidance versus CT guidance for peripheral lung biopsy: Performance according to lesion size and pleural contact. AJR Am J Roentgenol. 2018; 210 (3), W110–7.
- di Bardino DM, Yarmus LB, Semaan RW. Transthoracic needle biopsy of the lung. J Thoracic Dis. 2015; 7(Suppl 4): 304–16.
- 6. Sconfienza LM, Mauri G, Grossi F et al. Pleural and peripheral lung lesions: Comparison of US- and CTguided biopsy. Radiology. 2013; 266 (3): 930–5.
- Sartori S. Emerging roles for transthoracic ultrasonography in pleuropulmonary pathology. World J Radiol. 2010; 2 (2): 83.
- Yao X, Gomes MM, Tsao MS et al. Fine-needle aspiration biopsy versus core-needle biopsy in diagnosing lung cancer: A systematic review. Curr Oncol. 2012; 19 (1): 16–27.
- Winokur RS, Pua BB, Sullivan B et al. Percutaneous lung biopsy: Technique, efficacy, and complications. Semin Intervent Radiol. 2013; 30 (2): 121–7.
- Heerink WJ, de Bock GH, de Jonge GJ et al. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol. 2017; 27 (1): 138–48.
- Huang W, Ye J, Qiu Y et al. Ultrasound-Guided Percutaneous Core Needle Biopsy of Peripheral Pulmonary Nodules ≤ 2 cm: Diagnostic Performance, Safety and Influence Factors. Front Oncol. 2021; 11, 1584.
- Sheth S, Hamper UM, Stanley DB et al. Ultrasonography US Guidance for Thoracic Biopsy: A Valuable Alternative to CT. Radiology. 1999; 210 (3), 721-6.
- Anzidei M, Porfiri A, Andrani F et al. Imaging-guided chest biopsies: techniques and clinical results. Insights into imaging, 2017; 8 (4), 419-28.
- Guo YQ, Liao XH, Li ZX et al. Ultrasound-Guided Percutaneous Needle Biopsy for Peripheral Pulmonary Lesions: Diagnostic Accuracy and Influencing Factors. Ultrasound Med Biol. 2018; 44 (5): 1003–11.
- Yamamoto N, Watanabe T, Yamada K et al. Efficacy and safety of ultrasound (US) guided percutaneous needle biopsy for peripheral lung or pleural lesion: Comparison with computed tomography (CT) guided needle biopsy. J Thorac Dis. 2019; 11 (3): 936–43.
- Portela-Oliveira E, Souza CA, Gupta A et al. Ultrasound-guided percutaneous biopsy of thoracic lesions: high diagnostic yield and low complication rate. Clin Radiol. 2021; 76 (4): 281–6.
- Laurent F, Latrabe V, Vergier B et al. CT-guided transthoracic needle biopsy of pulmonary nodules smaller than 20 mm: Results with an automated 20-gauge coaxial cutting needle. Clin Radiol. 2000; 55 (4): 281–7.
- Guimarães MD, Marchiori E, Hochhegger B et al. CT-guided biopsy of lung lesions: Defining the best needle option for a specific diagnosis. Clinics. 2014; 69 (5): 335–40.
- Huang M de, Weng HH, Hsu SL et al. Accuracy and complications of CT-guided pulmonary core biopsy in small nodules: A single-center experience. Cancer Imaging. 2019; 19 (1): 1–10.
- Mills M, Choi J, El-Haddad G et al. Retrospective analysis of technical success rate and procedure-related complications of 867 percutaneous CT-guided needle biopsies of lung lesions. Clin Radiol. 2017; 72(12):1038–46.
- Tae JK, Lee JH, Lee CT et al. Diagnostic accuracy of CT-guided core biopsy of ground-glass opacity pulmonary lesions. AJR Am J Roentgenol. 2008; 190(1):234–9.
- Sartori S, Tombesi P, Trevisani L et al. Accuracy of transthoracic sonography in detection of pneumothorax after sonographically guided lung biopsy: Prospective comparison with chest radiography. AJR Am J Roentgenol. 2007; 188 (1): 37–41.
- Yeow KM, Su IH, Pan KT et al. Risk factors of pneumothorax and bleeding: Multivariate analysis of 660 CTguided coaxial cutting needle lung biopsies. Chest. 2004; 126(3):748–54.
- Guo YQ, Liao XH, Li ZX et al. Ultrasound-guided percutaneous needle biopsy for peripheral pulmonary lesions: diagnostic accuracy and influencing factors. Ultrasound Med Biol. 2018; 44.5: 1003-11.
- Nair A, Anirudh S, Moorthy S et al. CT-guided lung fine needle aspiration biopsy: Analysis of efficacy, yield and intricacies. Indian J Med and Paediatr Oncol. 2018; 39 (2): 178–83.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 15 Mart 2023 |
| Gönderilme Tarihi | 25 Nisan 2022 |
| Yayımlandığı Sayı | Yıl 2023Cilt: 62 Sayı: 1 |
