Korean Journal of Radiology

  • 제16권1호
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  • Pages.206-212
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  • 2015
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

CT-Guided Core Needle Biopsy of Pleural Lesions: Evaluating Diagnostic Yield and Associated Complications

  • Niu, Xiang-Ke (Department of Radiology, Affiliated Hospital of Chengdu University) ;
  • Bhetuwal, Anup (Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College) ;
  • Yang, Han-Feng (Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College)
  • 투고 : 2014.05.01
  • 심사 : 2014.11.05
  • 발행 : 2015.02.01
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: The purpose of this study was to retrospectively evaluate the diagnostic accuracy and complications of CTguided core needle biopsy (CT-guided CNB) of pleural lesion and the possible effects of influencing factors. Materials and Methods: From September 2007 to June 2013, 88 consecutive patients (60 men and 28 women; mean [${\pm}$ standard deviation] age, $51.1{\pm}14.4$ years; range, 19-78 years) underwent CT-guided CNB, which was performed by two experienced chest radiologists in our medical center. Out of 88 cases, 56 (63%) were diagnosed as malignant, 28 (31%) as benign and 4 (5%) as indeterminate for CNB of pleural lesions. The final diagnosis was confirmed by either histopathological diagnosis or clinical follow-up. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and complication rates were statistically evaluated. Influencing factors (patient age, sex, lesion size, pleural-puncture angle, patient position, pleural effusion, and number of pleural punctures) were assessed for their effect on accuracy of CT-guided CNB using univariate and subsequent multivariate analysis. Results: Diagnostic accuracy, sensitivity, specificity, PPV, and NPV were 89.2%, 86.1%, 100%, 100%, and 67.8%, respectively. The influencing factors had no significant effect in altering diagnostic accuracy. As far as complications were concerned, occurrence of pneumothorax was observed in 14 (16%) out of 88 patients. Multivariate analysis revealed lesion size/pleural thickening as a significant risk factor (odds ratio [OR]: 8.744, p = 0.005) for occurrence of pneumothorax. Moreover, presence of pleural effusion was noted as a significant protective factor (OR: 0.171, p = 0.037) for pneumothorax. Conclusion: CT-guided CNB of pleural lesion is a safe procedure with high diagnostic yield and low risk of significant complications.

키워드

참고문헌

  1. Feragalli B, Storto ML, Bonomo L. Malignant pleural disease. Radiol Med 2003;105:266-288; quiz 289-290
  2. Sartori S, Tombesi P, Trevisani L, Nielsen I, Tassinari D, Abbasciano V. Accuracy of transthoracic sonography in detection of pneumothorax after sonographically guided lung biopsy: prospective comparison with chest radiography. AJR Am J Roentgenol 2007;188:37-41 https://doi.org/10.2214/AJR.05.1716
  3. Mohammadi A, Oshnoei S, Ghasemi-rad M. Comparison of a new, modified lung ultrasonography technique with high-resolution CT in the diagnosis of the alveolo-interstitial syndrome of systemic scleroderma. Med Ultrason 2014;16:27-31 https://doi.org/10.11152/mu.2014.2066.161.am1so2
  4. He L, Zhang W, Zhang J, Cao L, Gong L, Ma J, et al. Diaphragmatic motion studied by M-mode ultrasonography in combined pulmonary fibrosis and emphysema. Lung 2014;192:553-561 https://doi.org/10.1007/s00408-014-9594-5
  5. Josephson T, Nordenskjold CA, Larsson J, Rosenberg LU, Kaijser M. Amount drained at ultrasound-guided thoracentesis and risk of pneumothorax. Acta Radiol 2009;50:42-47 https://doi.org/10.1080/02841850802590460
  6. Froudarakis ME. New challenges in medical thoracoscopy. Respiration 2011;82:197-200 https://doi.org/10.1159/000324266
  7. Diacon AH, Van de Wal BW, Wyser C, Smedema JP, Bezuidenhout J, Bolliger CT, et al. Diagnostic tools in tuberculous pleurisy: a direct comparative study. Eur Respir J 2003;22:589-591 https://doi.org/10.1183/09031936.03.00017103a
  8. Koegelenberg CF, Diacon AH. Pleural controversy: close needle pleural biopsy or thoracoscopy-which first? Respirology 2011;16:738-746 https://doi.org/10.1111/j.1440-1843.2011.01973.x
  9. Kim GR, Hur J, Lee SM, Lee HJ, Hong YJ, Nam JE, et al. CT fluoroscopy-guided lung biopsy versus conventional CT-guided lung biopsy: a prospective controlled study to assess radiation doses and diagnostic performance. Eur Radiol 2011;21:232-239 https://doi.org/10.1007/s00330-010-1936-y
  10. Adams RF, Gleeson FV. Percutaneous image-guided cutting-needle biopsy of the pleura in the presence of a suspected malignant effusion. Radiology 2001;219:510-514 https://doi.org/10.1148/radiology.219.2.r01ma07510
  11. Adams RF, Gray W, Davies RJ, Gleeson FV. Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma. Chest 2001;120:1798-1802 https://doi.org/10.1378/chest.120.6.1798
  12. Maskell NA, Gleeson FV, Davies RJ. Standard pleural biopsy versus CT-guided cutting-needle biopsy for diagnosis of malignant disease in pleural effusions: a randomised controlled trial. Lancet 2003;361:1326-1330 https://doi.org/10.1016/S0140-6736(03)13079-6
  13. Scott EM, Marshall TJ, Flower CD, Stewart S. Diffuse pleural thickening: percutaneous CT-guided cutting needle biopsy. Radiology 1995;194:867-870 https://doi.org/10.1148/radiology.194.3.7862993
  14. Gelbman BD, Cham MD, Kim W, Libby DM, Smith JP, Port JL, et al. Radiographic and clinical characterization of false negative results from CT-guided needle biopsies of lung nodules. J Thorac Oncol 2012;7:815-820 https://doi.org/10.1097/JTO.0b013e31824abd9c
  15. Lee IJ, Bae YA, Kim DG, Jung KS, Im HJ, Lee K, et al. Percutaneous needle aspiration biopsy (PCNAB) of lung lesions: 5 years results with focusing on repeat PCNAB. Eur J Radiol 2010;73:551-554 https://doi.org/10.1016/j.ejrad.2009.01.009
  16. Wu CC, Maher MM, Shepard JA. Complications of CT-guided percutaneous needle biopsy of the chest: prevention and management. AJR Am J Roentgenol 2011;196:W678-W682 https://doi.org/10.2214/AJR.10.4659
  17. Wu RH, Tzeng WS, Lee WJ, Chang SC, Chen CH, Fung JL, et al. CT-guided transthoracic cutting needle biopsy of intrathoracic lesions: comparison between coaxial and single needle technique. Eur J Radiol 2012;81:e712-e716 https://doi.org/10.1016/j.ejrad.2011.05.032
  18. Sconfienza LM, Mauri G, Grossi F, Truini M, Serafini G, Sardanelli F, et al. Pleural and peripheral lung lesions: comparison of US-and CT-guided biopsy. Radiology 2013;266:930-935 https://doi.org/10.1148/radiol.12112077
  19. Stigt JA, Boers JE, Groen HJ. Analysis of "dry" mesothelioma with ultrasound guided biopsies. Lung Cancer 2012;78:229-233 https://doi.org/10.1016/j.lungcan.2012.09.004
  20. Chang DB, Yang PC, Luh KT, Kuo SH, Yu CJ. Ultrasound-guided pleural biopsy with Tru-Cut needle. Chest 1991;100:1328-1333 https://doi.org/10.1378/chest.100.5.1328
  21. Heilo A, Stenwig AE, Solheim OP. Malignant pleural mesothelioma: US-guided histologic core-needle biopsy. Radiology 1999;211:657-659 https://doi.org/10.1148/radiology.211.3.r99jn03657
  22. Diacon AH, Schuurmans MM, Theron J, Schubert PT, Wright CA, Bolliger CT. Safety and yield of ultrasound-assisted transthoracic biopsy performed by pulmonologists. Respiration 2004;71:519-522 https://doi.org/10.1159/000080638
  23. Koegelenberg CF, Bolliger CT, Theron J, Walzl G, Wright CA, Louw M, et al. Direct comparison of the diagnostic yield of ultrasound-assisted Abrams and Tru-Cut needle biopsies for pleural tuberculosis. Thorax 2010;65:857-862 https://doi.org/10.1136/thx.2009.125146
  24. von Groote-Bidlingmaier F, Koegelenberg CF, Bolliger CT, Chung PK, Rautenbach C, Wasserman E, et al. The yield of different pleural fluid volumes for Mycobacterium tuberculosis culture. Thorax 2013;68:290-291 https://doi.org/10.1136/thoraxjnl-2012-202338
  25. Metintas M, Ak G, Dundar E, Yildirim H, Ozkan R, Kurt E, et al. Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial. Chest 2010;137:1362-1368 https://doi.org/10.1378/chest.09-0884

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