Pulmonary amyloidosis diagnosed by CT-guided transbronchial biopsy: a case report.

During a medical check-up, a nodular shadow was detected by chest X-ray in the right lower lung field of a 59-year-old man. On computed tomography (CT), the nodular lesion had a relatively well-defined, irregular margin. A fluoroscopy-guided bronchoscopic biopsy did not uncover any malignancy. Specimens from a subsequent CT-guided bronchoscopic biopsy revealed a pulmonary amyloid deposit. As a rule, it is difficult to exclude malignancy or confirm benign disease in cases of truly benign lesions, particularly if the lesions are difficult to biopsy. Amyloidosis is one of such conditions and requires reliable diagnostic methods to avoid unnecessary surgical resection. From our experience, we consider CT-guided bronchoscopic biopsy to be a safe and accurate procedure, even when applied to truly benign lesions.     

Fine Needle Aspiration in the Chest under CT Control

Over a 42 month perid 133 patients underwent 148 CT guided biopsies of 104 pulmonary lesions (78%), 21 mediastinal/hilar masses (16%) and 8 pleural lesions (6%). There were 48 cases (32%) complicated by a pneumothorax, of which 13 (9%) required a chest drain. Two cases each of minor haemopneumothorax (1.4%) and haematoma (1.4%) were found, and haemoptysis occurred in a single patient (0.7%). This low complication rate reflects the use of the 22 gauge Chiba needle, the small number of passes undertaken at each sitting and the wide range of lesion size. In four cases no diagnosis was established either at the time of biopsy or subsequently. There were 100 cases proven to be malignant, of which 81 were diagnosed at the first biopsy. Three further cases were regarded as suspicious of malignancy. Of the 29 patients with benign disease, a specific diagnosis was made in 10 (34%) and nonspecific inflammation was seen in 17 (59%) further patients. Fine needle aspiration under CT control is a useful and accurate diagnostic technique. It has widened the scope of lesions which can be biopsied, enabling small, deep or necrotic parenehymal lesions to be targeted accurately. A precise placement of the needle tip into pleural or mediastinal lesions is a further advantage. However, if an inadequate sample is obtained, the biopsy may need to be repeated.     

彩色多普勒超声介导周围型肺占位穿刺活检的临床应用

目的 观察彩色多普勒超声介导下穿刺活检对肺周围型占位性病变的安全性及诊断准确性,探讨该方法在临床中的应用价值。方法 在彩色多普勒超声引导下,应用自动活检装置对97例经CT检查显示为周围型肺占位病变患者进行穿刺活检。结果 取材成功率98.9%;93例获得正确诊断,组织病理学符合率95.9%;恶性71例,良性25例,其中假阴性3例,假阴性率4.1%(3/74);1例因取材量不足而无法做出病理诊断。结论 彩超介导下周围型肺占位病变的穿刺活检具有操作简便,成功率高,安全性好等优点,值得临床推广应用。     

超声导向活检在可疑小乳腺癌中的诊断应用

为了探讨超声引导粗针穿刺活检(ultrasound-guided core-needle biopsy,US-CNB)在可疑小乳腺癌(<2cm)肿块诊断中的实用价值及其影响因素,对50例可疑为乳腺癌的小肿块行超声引导粗针穿刺活检,其病理诊断结果与手术切除活检病理诊断结果进行对照。结果超声引导50个病灶中45个为恶性,5个为良性,术后活检证实2个假阴性,穿刺活检诊断阳性率为95.7%。初步研究结果提示,US-CNB是一种安全、准确、微创的操作,其诊断阳性率与穿刺针数、病变大小、病变组织类型等密切相关,诊断后应强调对良性病例进行随访。     

多层螺旋CT与立体定向穿刺系统导引下肺内小结节穿刺活检的临床应用

 目的 探讨MSCT与Pinpoint导引下穿刺活检术在肺内小结节诊断的临床应用价值。方法 32例肺内小结节（＜2 cm），均经MSCT与Pinpoint导引穿刺行组织学检查，分析穿刺病理取材正确率及并发症发生率。结果 32例均经手术病理及临床随访而明确诊断。其中恶性22例，良性病变10例，穿刺确诊30例；2例穿刺未取得病理结论，经手术证实分别为腺癌、错构瘤。恶性预测值及敏感性分别为100 %，95.7 ％，穿刺总准确性93.8 ％。气胸2例（6.2 ％），未经闭式引流或抽气处理；肺出血4例（12.5 ％），其中1例有一过性咳血，均未经特殊处理。结论 MSCT与Pinpoint导引下肺内小结节穿刺活检可以获得较好的组织学标本，是一种安全、准确的诊断和鉴别方法。     

CT fluoroscopy-guided closed-tip catheter placement before regional hyperthermia treatment of soft tissue sarcomas: 5-Year experience in 35 consecutive patients

Purpose: This study was designed to assess technical success and complications in patients with high-risk soft tissue sarcomas undergoing CT fluoroscopy-guided closed-tip catheter placement before treatment with combined chemotherapy and regional hyperthermia. Materials and methods: This retrospective study comprised all patients referred for insertion of closed-tip catheters for the introduction of thermometry probes before regional hyperthermia treatment at a single university centre from 2010 to 2015. Catheter placements were performed under local anaesthesia and intermittent CT fluoroscopy guidance. Technical success, complication rate, duration of catheter insertion and dose–length product (DLP) were analysed. Technical success was defined as intratumoural catheter placement suitable for subsequent thermometry. Results: A total of 35 procedures were performed on 35 patients (22 men, 13 women). In 34 out of 35 interventions catheters were inserted successfully; in one patient catheter placement was not feasible. No intra-interventional complications occurred. In six patients post-interventional complications were observed – two major (one abscess formation and one severe catheter dislocation) and four minor complications. Technical failure was observed in 11.4% of patients, especially catheter kinking. A total of 55 catheters were placed, with a mean number of 1.7?±?0.7 per patient. Mean total DLP was 723.2?±?355.9 mGy*cm. Conclusion: CT fluoroscopy-guided closed-tip catheter placement into high-risk soft tissue sarcomas was characterised by high technical success and relatively low complication rate. While major complications were rarely observed, catheter-kinking preventing successful thermometry represented the most frequent technical failure.     

超声引导穿刺活检对肺肿瘤的诊断价值

目的对其他检查方法不能做出定性诊断的肺肿瘤进行超声引导穿刺活检,探讨该方法对肺肿瘤的诊断价值.方法经胸超声检查确认肿瘤,并设定穿刺途径,采用日本八光21G PTC针,美国Bard自动活检枪和18G切割针.结果80例全部接受针吸细胞学检查,其中40例并接受组织学检查.细胞学检查诊断正确率为82.50%(66例),组织学检查诊断正确率为90%(36例).二种方法互补诊断正确率92.50%(74例).组织定性诊断正确率95%(76例).并发症4例(5%),其中气胸1例,咳血3例(3.75%),无严重并发症发生.结论超声引导穿刺活检对肺肿瘤的定性诊断为临床治疗提供了依据,有较高临床应用价值.     

多层螺旋CT引导下穿刺对孤立性肺结节的诊断价值

目的：探讨MSCT引导下穿刺孤立性肺结节应用价值.方法：经MSCT检查56例孤立性肺结节,穿刺经病理或随访证实,分析MSCT的敏感性、特异性、准确性及并发症.结果：56例中肺癌38例,假阴性4例,肺部良性结节14例无假阳性;对恶性结节敏感性90%、准确性92%、特异性100%,良性结节阴性预测值78%.一次穿刺成功率高,气胸发生率16%.结论：MSCT引导下穿刺孤立性肺结节准确性高而并发症较低,可作为鉴别结节良恶性的首选方法之一,对确定临床诊断及指导治疗具有重要的价值.     

Ultrasonographically guided 18-gauge automated core needle breast biopsy with post-fire needle position verification (PNPV)

BACKGROUND: Percutaneous imaging-guided core needle biopsy (CNB) is being used increasingly as an alternative to surgical biopsy for the diagnosis of breast lesions that are suspicious or highly suggestive of malignancy. The purpose of this study was to evaluate ultrasonographically (US) guided 18-gauge automated CNB with post-fire needle position verification (PNPV) in the assessment of US visible breast lesions. METHODS: Biopsy of 235 US visible breast lesions was performed using US-guided 18-gauge core needles (18-GCN). After firing the biopsy needle, an image was obtained in the orthogonal plane to confirm the precise post-fire position of the needle track before removing the needle. Needle core diagnoses were compared with surgical diagnoses in 235 lesions subsequently surgically excised. RESULTS: The median size of the lesions was 14 mm (range, 5-60 mm). Agreement between needle core and surgical diagnoses in the 235 lesions was 92% including 192 cancers, 28 benign lesions, and 3 high-risk lesions. In the remaining 12 discordant lesions, 4 were high-risk lesions and 8 were benign lesions. In all 8 benign lesions, imaging-histological discordance was present. The sensitivity of US guided 18-GCNB for breast cancer was 96% (199 of 207). In 71% (167/235) of the cases only one core with PNPV was made. No complications occurred. CONCLUSION: US-guided 18-GCNB for sonographically-demonstrated discrete mass lesions with PNPV is an accurate core needle biopsy technique of breast cancer. During the course of tissue sampling, evaluating the post-fire needle tip position by obtaining an orthogonal view with ultrasonographic guidance is the key to predicting the yield regardless of the size of the needle or the number of core samples.     

CT‐guided percutaneous lung biopsies in patients with haematologic malignancies and undiagnosed pulmonary lesions

We searched the electronic patient database at The University of Texas M. D. Anderson Cancer Center for patients who underwent computed tomography (CT)‐guided needle biopsy between January 2001 and December 2005. Inclusion criteria were a known history of haematologic malignancy and a newly detected, undiagnosed pulmonary lesion on chest CT that required tissue sampling for diagnosis; 213 met these criteria. We analysed the biopsy results for diagnostic yield, factors affecting diagnostic yield and effect on treatment. Of 213 procedures, 191 (89.7%) yielded sufficient material for pathologic analysis; 130 (60%) yielded specific diagnoses, while 61 (28.6%) yielded nonspecific benign diagnoses. Lesions larger than 1 cm, cavitary lesions and lung masses were more likely to yield a specific diagnosis than were lesions smaller than 1 cm, lung nodules and consolidations. The most common specific diagnoses were malignancy (62.8%) and infection (34.3%). The latter was more common in patients with leukaemia, cavitary lung lesions or consolidations, active underlying malignancy, neutropenia, respiratory signs and symptoms and/or fever, bone marrow transplant recipients, and in patients receiving chemotherapy. Lung lesions discovered upon follow‐up imaging in patients who did not have any respiratory signs/symptoms or fever were mostly malignant. Therapeutic changes were more likely after a specific diagnosis than after a nonspecific diagnosis or a nondiagnostic biopsy (88.4% vs. 18.1%; p < 0.0001). CT‐guided lung biopsy has a high diagnostic yield in patients with haematologic malignancies that present with unexplained pulmonary lesions and provides a specific diagnosis in a majority of these patients, leading to therapeutic changes. Copyright © 2009 John Wiley & Sons, Ltd.     

Accuracy of Fine Needle Aspiration Cytology from Breast Masses in Thailand

Objective: To evaluate the accuracy and diagnostic performance of fine needle aspiration FNA cytology indiagnoses of breast masses. Methods: Women who had FNA diagnoses for breast masses and underwentsubsequent histopathologic evaluation during January 2003-December 2006 were accessed from the archive ofthe Anatomical Pathology Department of our institution. Cytologic diagnoses were classified as unsatisfactory,benign, atypical probably benign, suspicious probably malignant, and malignant, and were compared to thehistopathologic diagnoses obtained from core needle biopsy, excisional biopsy, or mastectomy to give an assessmentof the diagnostic performance of FNA. Results: A series of 190 breast masses were identified during the studyperiod. The FNA cytological diagnosis was unsatisfactory due to inadequate specimens in eight cases (4.2%).The diagnoses in the remaining 182 cases were: benign lesions in 98 (53.9%); suspicious for malignancy in 31(17.0%); and malignant in 53 (29.1%). From the subsequent histopathologic diagnoses, 6/98 cases of benigncytology turned out to be malignant lesions (false negatives); 22/31 cases of suspicious cytology were trulymalignant while the other nine were benign; and only 1/53 with malignant cytology was benign (false positive),the lesion being a fibroadenoma . The overall accuracy, sensitivity, specificity, positive predictive value, andnegative predictive value were 91.2% (95% confidence interval [CI], 87.6%-94.8%), 92.5% (95% CI, 88.7%-96.3%), 90.2% (95% CI, 85.9%-94.5%), 88.1% (95% CI, 83.4%-92.8%) and 93.9% (95% CI, 90.4%-97.4%),respectively. Conclusions: FNA cytology is highly accurate for diagnosis of breast masses. However, the clinicianshould correlate FNA cytological results with physical examination and imaging findings to prevent false negativeand false positive events and to obtain optimal management for their patients.     

肺野边缘型肿瘤的CT引导下经皮肺活检术

目的探讨CT引导下的经皮肺活检法对肺野内结节性病变的诊断性能及合并症的发生率.方法采用CT下经皮肺活检法对肺野内的249个结节性病灶进行了穿刺活检.肿瘤直径6mm～100mm(平均23.5mm),胸膜到肿瘤的深度为2mm～80mm(平均56mm).结果确诊为恶性165例,灵敏性为89%,良性的确诊率为85%.术后发生气胸36例(14%),肺内出血26例(10%).结论CT引导下的经皮肺活检法安全、易行,尤其对确诊邻近胸膜的病灶具有意义.     

Percutaneous CT‐guided fine‐needle aspiration of pulmonary lesions: Results and complications in 409 patients

The purpose of this study was to report our centre’s experience in the results and complications of percutaneous CT‐guided lung biopsy. A retrospective review of 409 patients who underwent percutaneous CT‐guided fine‐needle aspiration of suspicious lung lesions for more than 5 years was carried out. Nodule sizes ranged from 0.6 to 10 cm. The calibre of the needle used was 21–23 G. Specimen adequacy and patient outcome were evaluated. Each case was reviewed for complications. Sufficient diagnostic material was obtained in 369 (90%) of the 409 fine‐needle aspirations. Diagnosis was malignancy in 290 (70%) samples, four (1%) samples were suspicious for malignancy, 65 (16%) samples were negative for malignancy and definite benign findings were identified in 10 (3%) specimens. There were 25 false‐negative cases and one false‐positive case. Sensitivity was 92% and specificity 98%. Pneumothorax was the most common complication and occurred in 17 (4%) patients. Only one of them required thoracic drainage. Blood effusion around the lesion or along the needle track was detected on the post‐biopsy CT in 8 (2%) patients. However, only one of them suffered from a mild haemoptysis. Percutaneous CT‐guided biopsy is an effective and fast procedure for diagnosis of suspected pulmonary malignancy, with a low complication rate.     

探讨周围型肺部病变的确诊方法

目的　探讨确诊周围型肺部病变安全、可靠的活检方法。方法　 4 2例在穿刺前先作CT扫描确定最佳的穿刺点、进针深度和角度。将取得的条型组织送病理检查。结果　 4 2例中确诊 4 1例 ,阳性率 97.6 % ,假阴性为 2 .4 % ,无假阳性。小量咯血 1例 (2 .4 % ) ,气胸 2例 (4.7% ) ,肺压缩均小于 2 0 %。结论　CT引导下经皮肺穿刺活检术是确诊周围型肺癌安全、可靠的方法。     

CT-GUIDED PERCUTANEOUS TRANSTHORACIC FINENEEDLE ASPIRATION BIOPSY OF SMALL PERIPHERAL PULMONARY LESIONS

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CT引导下肺部病变穿刺活检的临床应用价值及并发症的预防

 目的探讨CT引导下肺部病变穿刺活检的临床应用价值及并发症的预防。方法对80例患者96个病灶在CT引导下做了108次穿刺。结果细胞学阳性率93.7%(75/80);组织学阳性率95%(76/80)。恶性肿瘤准确率93.8%(62/65);良性病变准确率80%(12/15);并发症气胸7.5%(6/80),咳血2.5%(2/80)。结论CT引导下肺部病变穿刺活检安全、准确、高效。严格、娴熟、规范的操作可减少并发症的发生。     

18F-FDG PET/CT显像中肺外病变对肺癌的辅助定性诊断价值

背景与目的 ¹⁸F-脱氧葡萄糖（fluorodeoxyglucose,FDG）正电子发射体层摄影术/计算机体层摄影术（positron emission tomography/computed tomography,PET/CT）对肺癌和部分肺良性病变的鉴别诊断仍有一定困难,本研究旨在探讨PET/CT显像中肺外病变对肺癌的辅助定性诊断价值。方法回顾性分析126例行PET/CT检查的疑诊肺癌病例。初始诊断仅根据肺内病变的PET表现、平均标准摄取值（mean standardized uptake value,SUVmean）和CT征象,然后根据肺外病变情况对肺内病变的诊断进行修正,比较修正前后诊断结果有无差异。结果 PET/CT发现81例同时伴有肺外病变,肺外转移性病变使13例可疑恶性修正为肯定恶性,1例良性修正为肯定恶性;肺外非转移性病变使2例可疑恶性修正为肯定恶性,1例可疑恶性修正为良性。除2例全身结核被错误修正为恶性外,其它15例经病理证实均为正确修正。修正前后PET/CT的诊断结果差异有统计学意义,修正诊断率为13.5%（17/126）,修正诊断正确率为88.2%（15/17）。结论肺外病变的发现对肺癌的术前定性有着较好的实用价值,提高了诊断效能,但仍然要注意与全身多发结核等炎性病变鉴别。     

CT模拟定位系统引导下经皮肺穿刺在老年肺癌的应用价值

Objective: To evaluate the value of CTS-guided percutaneous transthoracic biopsy for the diagnosis of pulmo-nary lesions in elder patients. Methods: The intact data of 78 elder patients underwent percutaneous pulmonary biopsy with a spring-core biopsy needle under CTS guidance were analyzed. The diagnosis of all the cases was confirmed by pathology and follow-up. Results: Ninety-five lung biopsies were performed in 78 cases and satisfactory tissue specimens obtained in all cases, the success rate was 100%. The diagnosis for malignant tumors and benign lesions was 72 and 6, respectively. The overall accuracy rate was 100%. Pneumothorax was noted in 5 cases (6.4%) and hemoptysis seen in 10 patients (12.8%). Conclusion: CTS-guided percutaneous transthoracic biopsy with a spring-core biopsy needle are accurate, safe and quick for pulmonary lesions in elder patients.     

Accurate diagnosis of musculoskeletal lesions by core needle biopsy

BACKGROUND: Percutaneous needle biopsy has many advantages over open biopsy in the treatment of neoplasms. However, the accuracy of needle biopsy in the diagnosis of musculoskeletal lesions has not yet been established. Here, we evaluate the accuracy and limitations of the procedure for musculoskeletal lesions. METHODS: The diagnoses of 163 needle biopsies (bone, 91; soft tissue, 72) performed on 157 consecutive patients using a Jamshidi needle or an Ostycut needle for bone lesions, or a Tru-cut needle for soft tissue lesions were compared with the final diagnoses made by open biopsy and/or a definitive operation. RESULTS: One hundred forty-three specimens (88%) were determined to be adequate for histological examination. Obtaining undamaged cores from very hard bony lesions or sclerotic cyst walls proved difficult. A pathologist with experience in musculoskeletal lesions was able to differentiate malignant tumors from benign lesions in 97% of the cases (bone, 100%; soft tissue, 94%) and arrive at a specific diagnosis in 88% (bone, 96%; soft tissue, 78%) when adequate cores were obtained. Differentiating a well-differentiated liposarcoma from a benign lipoma and inflammatory lesions from benign tumorous conditions, was difficult. The overall accuracy was 77% (bone, 85%; soft tissue, 68%). There was no morbidity related to the procedure. CONCLUSION: The results indicate that needle biopsy is safe and accurate for diagnosing musculoskeletal lesions.     

Risk of needle tract seeding of breast cancer: cytological results derived from core wash material

Needle track seeding has been recognized as a possible, albeit rare, complication of breast core needle biopsy. The purpose of this study was to assess the risk of needle tract seeding of breast cancer from cytological results derived from core needle wash material. The study included biopsies of 207 breast cancers performed using ultrasonographically guided 18-gauge core needles. Each core needle without exposed sample notch was washed in saline solution immediately after removing the needles. Cytology derived from core wash material was performed by saline solution lavage of the fragments using a cytocentrifuge. The cytological diagnoses were divided into five categories: benign, atypical/indeterminate, suspicious/probably malignant, malignant and unsatisfactory. Atypical/indeterminate, suspicious/probably malignant and malignant categories were considered to represent positive cases of needle track seeding of breast cancer, whereas benign and unsatisfactory categories were counted as negative cases. Cytological diagnoses of the 207 lesions were as follows: 26 lesions (12%) were benign, 18 lesions (9%) were atypical/indeterminate, 37 lesions (18%) were suspicious/probably malignant, 79 lesions (38%) were malignant, and 47 lesions (23%) were unsatisfactory. The incidence of positive cases of cytology derived from core wash material was 65% (134/207). The 25% frequency of positive cases of invasive lobular carcinoma was significantly lower than the frequencies of DCIS (74%) and invasive ductal carcinoma (69%) (P = 0.001 and P < 0.01). The frequency of positive cases in the multiple passes group was 75%, which was slightly, although not significantly, higher than the 66% frequency in the single pass group (P = 0.3). In conclusion, the incidence of positive cases of cytology derived from ultrasonographically guided breast core needles' wash material was 65%. The clinical significance is debatable; however, there may be a theoretical risk of local recurrence if the tract is not excised or radiotherapy not given.