usefulness of lung biopsy with ct-guided coaxial technique in

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Usefulness of lung biopsy with CT-guided coaxial techniquein histological diagnosis of lung cancer

Poster No.: C-2018

Congress: ECR 2013

Type: Scientific Exhibit

Authors: J. A. Gallego Sánchez, N. Riera Bevia, B. Pomares Rey, Z.Sánchez Acevedo, E. Ramos Gavila, E. Alsina Seguí; Elche/ES

Keywords: Lung, Oncology, Interventional non-vascular, CT, Percutaneous,Biopsy, Neoplasia

DOI: 10.1594/ecr2013/C-2018

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Purpose

In the treatment of lung cancer, histology and molecular studies (EFGR, K-RAS, TTF-1,…) are important factors for individualized therapy. It is necessary to obtain sufficientsample tissue for microscopic, immunohistochemical and molecular analysis.

CT-guided coaxial biopsy obtains samples for cytology and histology using a fine needleaspiration (FNA) and a semi-automated cutting needle (SCN) through an introducerneedle with a single pleural puncture.

The objectives, of this study, are:

- To describe the CT-guided coaxial biopsy technique obtaining cytologic and histologicmaterial.

- To assess the sensitivity in the histological diagnosis and complications rate.

Methods and Materials

49 biopsies of thoracic lesions were performed under CT-guided coaxial technique witha 19G introducer needle.

Access to the lesions was as perpendicular as possible to the pleura and chose theshortest approach that crossed the least amount of lung parenchyma and avoidedvessels, bronchia, bullae and fissures.

The skin entry was sterilised with povidone-iodine solution and infiltrated with lidocaine.

The introducer needle (19G) was placed in the proximal edge of the lesion with patient'sbreathing suspended. Fig. 1 on page 3

The inner stylet was removed and the 20G semiautomatic cutting needle (SCN) pushedto the end of the guiding cannula with a throw length of 10 mm or 20 mm according tothe lesion size and structures behind the lesion. Fig. 2 on page 4

The SCN was rotated 90 ° after each pass and an average of 3.5 core specimens forhistology were obtained. Fig. 3 on page 5 Fig. 4 on page 6

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The 20G SCN was then exchanged for a FNA (22G) through the coaxial system Fig. 5on page 7 performing two passes and sending the samples in smears and withinsyringes with ethanol for cytological analysis.

After each pass the inner stylet was placed inside the introducer needle to prevent airembolism.

The punctures were performed without an on-site cytopathologist.

If the patient experienced hemoptysis during procedure, biopsy was discontinued.

Lung CT scan was performed after biopsy and an erect chest radiograph was performed3 hours after to rule out complications.

The results were correlated with surgical specimens if available or follow-up of the lesions.Those without a specific diagnosis but stable for two years were considered benign.

Images for this section:

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Fig. 1

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Fig. 2

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Fig. 3

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Fig. 4

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Fig. 5

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Results

The mean age of patients was 63.4 years, 68.2% of them were men and 31.8% women.

The mean diameter of lung lesions was 5.1 cm and the mean distance to pleura 2.1 cm.

In 44 cases a definitive diagnosis was obtained, 36 malignant and 8 benign.

The mean size was 4.2 cm for malignant lesions and 7,1 cm for benign lesions

The mean distance to pleura was 2.3 cm for malignant lesions and 1,3 cm for benign.

Table 1: Characteristics of lesionsReferences: Hospital General Universitario de Elche - Elche/ES

In 39 cases sample tissue was obtained with 20G-SCN for histological analysis and in39 cases sample was obtained with 22G-FNA for cytologic analysis.

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The sensitivity for malignant and benign lesions was higher with 20G-SCN (87.9% vs69.7%, and 33% vs 0%). The false negative rate for 20G-SCN was lower (12.1% vs30.3%).

Table 2: Sensitivity and false negative rate in samples obtained with 20G-SCN and22G-FNAReferences: Hospital General Universitario de Elche - Elche/ES

In 34 cases cytological and histological samples were obtained in the same procedure.

In these cases the sensitivity of 20G-SCN was higher for diagnosis of malignant lesions(86.7% vs 70%) and benign lesions (33% vs 0%).

By combining cytologic and histologic samples the sensitivity increased (90%) formalignant lesions.

The false negative rate was lower for 20G-SCN (13.3% vs 30%).

Table 3: Sensitivity and false negative rate in samples obtained with 20G-SCN and22G-FNA in the same procedure.References: Hospital General Universitario de Elche - Elche/ES

Pneumothorax with chest tube drainage happened in 6,1% of patients. Other 6.1% ofpatients had mild hemoptysis. These rates are similar to those reported in the literature.

No serious complications occurred.

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Images for this section:

Table 1: Characteristics of lesions

Table 2: Sensitivity and false negative rate in samples obtained with 20G-SCN and 22G-FNA

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Table 3: Sensitivity and false negative rate in samples obtained with 20G-SCN and 22G-FNA in the same procedure.

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Conclusion

Lung biopsy with a 20G-SCN has a higher sensitivity and lower false negative rate than22G-FNA for thoracic lesions.

Combining cytological and histological samples increases sensitivity in diagnosis ofmalignant lesions.

The CT-guided coaxial lung biopsy is a safe technique that allows multiple SCN and FNAsamples with a single pleural puncture allowing a specific histopathologic diagnosis. It'san important technique in individualized therapy of lung cancer.

References

1.- Manhire A., Charig M., Clelland C. et al. Guidelines for radiologically guided lungbiopsy. Thorax 2003; 58;920-936.

2..- Klein J.S., Salomon G., Stewart E.A. Transthoracic needle biopsy with a coaxiallyplaced 20-gauge automated cutting needle: Results in 122 patients. Radiology 1996;198: 715-720.

3.- Laurent F., Latrabe V., Vergier B., Michel P. Percutaneous CT-guided biopsy ofthe lung: Comparison between aspiration and automated cutting needles using acoaxial technique. Cardiovascular and Interventional Radiology 2000; 23: 266-272

4.- Lucidarme O., Howarth N., Finet J-F., Grenier P. Intrapulmonary lesions:Percutaneous automated biopsy with a detachable 18-gauge, coaxial cuttingneedle. Radiology 1998; 207: 759-765.

5.-Boiselle P., Shepard J., Mark E. et al. Routine addition of an automated biopsydevice to fine-needle aspiration of the lung: A prospective assessment. AJR 1997;169: 661-666.

6.-Sigel CS., Friedlander MA., Zakowski Mf, et al. Subtyping or non-small cell lungcarcinoma: comparison of cytology and small biopsy specimens. Mod Pathol 2010;23: 414 A.

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7.-Travis W., Brambilla E., Noguchi M. et al. International Association for thestudy of lung cancer/American Thoracic Society/European Respiratory SocietyInternational Multidisciplinary Classification of Lung Adenocarcinoma. Journal ofThoracic Oncology 2011; 6 (2): 244-285.

8.-Langer C., Besse B., Gualberto A., et al. The evolving role of histology in themanagement of advanced non-small-cell lung cancer. Journal of Clinical Oncology2010; 28(36):5311-5320

9.-Geraghty P., Kee S., McFarlane G. et al. CT-guided transthoracic needle aspirationbiospsy of pulmonary nodules: needle size and pneumothorax rate. Radiology2003; 229:475-481.

10.- Wu C., Maher M., Shepard J. et al. Complications of CT-guided percutaneousneedle biopsy of the chest: Prevention and Management. AJR 2011; 196: w678-w682.

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