CT-guided transthoracic needle biopsy: a comparison between automated biopsy gun and fine needle aspiration

AIMS: We retrospectively investigated the diagnostic accuracy and complication rate of transthoracic core biopsy using an automated biopsy gun and compared the findings with those of aspiration needle biopsy. PATIENTS AND METHODS: Seventy-three patients underwent 74 core biopsy procedures and 50 patients underwent 52 aspiration biopsy procedures. Of these, a final diagnosis was obtained in 107 lesions with surgery or clinical course. Fifteen patients in which a final diagnosis was not obtained were excluded from the study on diagnostic accuracy. Thus, in the study of diagnostic accuracy, 63 core biopsy procedures for 62 lesions are included. Core biopsy was performed with an 18 G cutting needle using an automated biopsy gun. Aspiration biopsy was performed with a 20 G aspiration needle. RESULTS: Core biopsy yielded sufficient material in 57/63 procedures (90.5%). A correct diagnosis was obtained in 36 procedures (85.7%) for malignant leisons and a specific benign diagnosis was obtained in 11 procedures (52.4%). Aspiration biopsy yielded a correct diagnosis in 26 procedures (81.3%) for malignant leisons and in seven (46.7%) for benign lesions. The overall correct diagnosis were 75.8% and 71.7% with core biopsy and aspiration biopsy, respectively. Core biopsy gave a higher predictive rate than that of aspiration biopsy for both benign and malignant lessons (P < 0.02). Pneumothorax occurred in 18/74 (24.3%) patients with core biopsy and in 18/45 (40.0%) patients with aspiration biopsy. Of these, three with core biopsy and two with aspiration biopsy needed tube drainage. The other complication was haemoptysis, which occurred in six patients following core biopsy and in three after aspiration biopsy. All nine cases subsided spontaneously. There were no fatal complications. CONCLUSIONS: Core biopsy with a biopsy gun increase the diagnostic accuracy with a higher histologic predictive rate and no obvious additional risk of complications.     

Implantation metastasis after percutaneous transthoracic needle aspiration biopsy

The risk of tumour spread at aspiration biopsy of pulmonary tumours through the needle track has been analyzed by reviewing the case histories of 1 264 patients with a malignant tumour demonstrated by needle biopsy. Only in one case did metastatic tumour growth develop at the site of the biopsy. The history of this case is presented and the available literature on the subject discussed.     

Microbiologically verified diagnosis of infectious spondylitis using CT-guided fine needle biopsy

Using a computed tomography (CT)-guided technique we have been able to obtain fine needle spine biopsies directly from an affected vertebra or disk plate in 14 patients suspected of infectious spondylitis. The bioptic material was cultivated immediately and incubated for 14 days. Cultures from eight patients were positive. No single microbiological agent was predominant though coagulase-negative staphylococci were frequent. In no case were mycobacteria found. Bioptic material from six patients did not give rise to growth of microorganisms. We were able to successfully treat the eight patients with a culture-positive biopsy. We think that biopsies are crucial for establishing a microbiological diagnosis. The whole procedure takes less than one hour; it is performed under local anaesthesia and is thus not very stressful for the patient: The success rate for obtaining a positive spine biopsy was 57%.     

Utility of electron microscopy in the assessment of transthoracic needle lung biopsy specimens

The soluble form of the leukocyte membrane antigen CD14 is known to increase the sensitivity of endothelial and epithelial cell lines to bacterial lipopolysaccharide (LPS). This molecule also directly induces cytokine production in monocytes. Here, the effect of sCD14 and LPS on the release of IL-6 and IL-8 by human bronchial epithelial cells (HBECs) was studied. Soluble CD14 induced cytokine production both in the presence and absence of LPS. In addition, neither sCD14 nor anti-CD14 monoclonal antibody which blocks the interaction of LPS with CD14 had any effect on the binding of LPS to HBECs. These data suggest that sCD14 may induce the release of IL-6 and IL-8 from HBECs. However, the binding of LPS to bronchial epithelium appears to be mediated by CD14-independent mechanisms.     

CT-guided spinal biopsy in spondylodiscitis

Since February 1987 percutaneous CT-guided spine biopsy was performed in 18 patients with spondylodiscitis at the X-ray Department of Bispebjerg Hospital. Eleven cases were spontaneous and seven followed spinal surgery. The infection was located in five cases in the thoracic spine and in 13 cases in the lumbar spine. Only one biopsy was performed during general anaesthesia, the rest under local anaesthesia. No complications were observed. The bioptic material was cultivated immediately beside the patient and incubated for 14 days. The infective organism was isolated in 12 cases (67%). Thus, material obtained through a fine needle was satisfactory for microbiological investigation. A biopsy is crucial for establishing a microbiological diagnosis and thereby enabling prompt adequate treatment.     

The role of transthoracic needle biopsy for the diagnosis and staging of lung cancer

Percutaneous transthoracic needle biopsy (TNB) is a simple and safe procedure with high diagnostic accuracy for the diagnosis and staging of cancer in the lung, hilum, and mediastinum. The complication rate is low and consists primarily of pneumothorax, with only a small percentage of these requiring chest tube reexpansion. Major complications are rare. Computed tomographically guided biopsy is a powerful adjunct to fluoroscopic biopsy and expands the application of TNB to include most thoracic lesions. TNB is the initial diagnostic procedure of choice in peripheral lung lesions, suspected focal metastases, and most hilar and mediastinal masses. Its proper role in the diagnosis and staging of lung cancer requires the close collaboration of the radiologist, cytopathologist, and the patient's primary physician.     

CT-guided brachial plexus biopsy

We describe a technique for conducting a CT-guided biopsy of the brachial plexus region, report two illustrative cases, discuss potential complications, and conclude that, in selected cases, biopsy of lesions in the region of the brachial plexus can be performed safely with CT guidance.     

Chronic pulmonary histoplasmosis in Brazil: report of two cases with cavitation diagnosed by transthoracic needle biopsy

OBJECTIVE: To compare fat-suppressed fast spin-echo (FSE) T2-weighted images with gradient-recalled echo (GRE) T2*-weighted images in the evaluation of anteroinferior labral tears. DESIGN: MR images were retrospectively reviewed by two radiologists masked to the history and arthroscopic findings. They separately interpreted the anteroinferior labrum as torn or intact, first on one pulse sequence and then, 4 weeks later, on the other sequence. The MR interpretations were correlated with the arthroscopic findings. PATIENTS: Nine patients with anteroinferior labral tears, and nine similarly-aged patients with normal, labra were studied. RESULTS AND CONCLUSIONS: Observer 1 had a sensitivity of 0.56 on the GRE images and 0.67 on the FSE images (P > 0.5), with a specificity of 1.0 for both sequences. Observer 2 had a sensitivity of 0.78 and a specificity of 0.89 for both sequences. In this small study there is no significant difference between GRE and fat-suppressed FSE images in their ability to diagnose anteroinferior labral tears. When evaluating the labrum with conventional MRI, axial fat-suppressed FSE T2-weighted images can be used in place of GRE images without a loss of accuracy.     

Solitary fibrous tumor of the pleura: a report of five cases diagnosed by transthoracic cutting needle biopsy

Five patients had a solitary fibrous tumor of the pleura; a well-known but rare entity. In all cases, biopsy by a transthoracic cutting needle (Tru-Cut; Travenol; Deerfield, IL) yielded specimens adequate for histologic analysis and gave the clue to the diagnosis. In four patients, surgical resection confirmed the diagnosis. The opportunity for and interest in diagnosing these tumors by transthoracic cutting needle biopsy before surgery are discussed. An accurate diagnosis of solitary fibrous tumors of the pleura can be made by a minimally invasive procedure; this allows for a more informed allocation of surgical resources.     

Granulomatous prostatitis on needle biopsy

Sixty-four children with malignant brain tumours diagnosed at less than 3 years of age were reported to the Finnish Cancer Registry from 1975 to 1993. The survival rate has improved significantly: the 5-year survival rate was 26% for all children, 13% for children diagnosed during 1975-85 (n = 30) and 40% for those diagnosed during 1986-93 (n = 34). Of the surviving children in 1986-93, 43% were categorized in Bloom's group I or II and could lead active lives without major disabilities. The remaining children had severe neurologic late complications, such as hemiplegia, intractable seizures, and mental retardation.     

Artificial paravertebral widening for percutaneous CT-guided adrenal biopsy

A percutaneous adrenal biopsy under CT guidance is described. The biopsy was performed after injection of physiologic saline solution into the paravertebral space, creating a wider pathway for needle insertion. This technique has been previously reported for biopsy of thoracic lesions, but in our case it was used for biopsy of a relatively inaccessible adrenal lesion. This artificial window that is formed by displacing the pleura laterally allows a direct and potentially safer access route to the retroperitoneum, avoiding puncture of pleura, diaphragm, and abdominal structures.     

Percutaneous needle muscle biopsy in the horse

The use of the technique of percutaneous needle biopsy in obtaining skeletal muscle samples in the horse is described. The biochemical, ultrastructural and histochemical investigations that can be carried out on this biopsy specimen are outlined. Analyses performed on the specimen may be used to obtain information on racing potential and state of fitness. These studies on normal horses will provide information for future investigations into the structural and biochemical alterations in muscle disorders in the equine.     

Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules

OBJECTIVES: Uncontrolled data often have to be used in clinical decision marking and in the planning of clinical trials. When such data are used as a basis for comparing different treatment strategies, they tend to generate sources of bias such as inconsistent patient selection, misrepresentation, and measurement errors. A rational usage of uncontrolled data requires identification and handling of different systematic errors when comparing different treatment strategies. Therefore we sought to define a systematic error that deserves more attention in the clinical literature. METHODS: Using hypothetical examples, we illustrate the bias introduced by variations in "lead time," proportions of so-called prevalent/incident cases, and lengths of follow-up between reference and treatment groups. RESULTS: We found these three situations conceptually identical. Bias is introduced because different parts of a nonconstant hazard curve over time are observed. CONCLUSIONS: The systematic error described is potentially important in uncontrolled data provided the hazard rate over time is nonconstant. Thus the seemingly worse outcome after external beam radiation therapy as compared to the outcomes of deferred treatment of radical prostatectomy in compiled patient series of localized prostate cancer may in some part be explained by bias due to observation of different parts of a nonconstant hazard curve over time.     

Transcutaneous needle biopsy of the lung

Spinal muscular atrophy (SMA) is a frequent autosomal recessive neurodegenerative disorder leading to weakness and atrophy of voluntary muscles. The survival motor neuron gene (SMN) is a strong candidate for SMA and present in two highly homologous copies (telSMN and cenSMN) within the SMA region (5q11.2-q13.3). More than 90% of SMA patients show homozygous deletions of at least exon 7 of telSMN, whereas absence of cenSMN seems to have no clinical consequences. In 23 non-deleted SMA patients, we searched for intragenic mutations of the SMN genes in exons 1-7 and the promotor region by single strand conformation analysis. We identified two different missense mutations, S2621 and T2741, in exon 6 of telSMN in three independent SMA families, providing further evidence for the telSMN gene as a SMA determining gene. Both mutations, as well as two previously described mutations (Y272C and G279V) are located within a highly conserved interval from codon 258 to codon 279 which seems to be an important functional domain of the telSMN protein. Recently, this region has been shown to contain a tyrosine/glycine-rich motif, which is also present in various RNA binding proteins, suggesting a potential role of SMN in RNA metabolism. Missense mutations might be useful for in vivo and transgenic experiments and further investigations on understanding the function of the telSMN protein.