Preventive tract embolization with gelatin sponge slurry is safe and considerably reduces pneumothorax after CT-guided lung biopsy with use of large 16–18 coaxial needles

Objective: To evaluate the clinical impact of the tract embolization technique using gelatin sponge slurry after percutaneous CT-guided lung biopsy. Methods: We retrospectively compared coaxial needle CT-guided lung biopsies performed without embolization (100 patients) and with the tract embolization technique using a mixture of iodine and gelatin sponge slurry (105 patients) between June 2012 and July 2020. Uni- and multivariate analyses were performed between groups to determine risk factors of pneumothorax. Results: Patients with gelatin sponge slurry tract embolization had statistically lower rates of pneumothorax ((17.1% vs 39%, p < 0.001). In univariate analysis, tract embolization (OR = 0.32, CI = 0.17–0.61 p<0.001) and nodule size >2 cm (OR = 0.33 CI = 0.14–0.8 p = 0.013) had a protective effect on pneumothorax. The puncture path lengths > 2–20 mm and >20 mm were risk factors for pneumothorax (OR = 3.35 IC = 1.44–8.21 p = 0.006 and OR = 4.36 CI = 1.98–10.29 p<0.001, respectively). In multivariate regression analysis, tract embolization had a protective effect of pneumothorax (OR = 0.25, CI = 0.12–0.51, p < 0.001). The puncture path lengths > 2–20 mm and >20 mm were risk factors for pneumothorax (p = 0.030 and p = 0.002, respectively). Conclusions: The tract embolization technique using iodinated gelatin sponge slurry is safe and considerably reduces pneumothorax after percutaneous CT-guided lung biopsy. Our results suggest that it could be use in clinical routine. Advances in knowledge: The systemic use of gelatin sponge slurry is safe and reduces considerably the rate of pneumothorax upon needle removal when CT-guided core biopsies are performed using large 16–18G coaxial needles.

C-Arm Cone-Beam CT Virtual Navigation Versus Conventional CT Guidance in the Transthoracic Lung Biopsy: A Case-Control Study

C-arm cone-beam computed tomography (CBCT) virtual navigation-guided lung biopsy has been developed in the last decade as an alternative to conventional CT-guided lung biopsy. This study aims to compare the biopsy accuracy and safety between these two techniques and explores the risk factors of biopsy-related complications. A total of 217 consecutive patients undergoing conventional CT- or C-arm CBCT virtual navigation-guided lung biopsy from 1 June 2018 to 31 December 2019 in this single-center were retrospectively reviewed. Multiple factors (e.g., prior emphysema, lesion size, etc.) were compared between two biopsy techniques. The risk factors of complications were explored by using logistic regression. The patients’ median age and male-to-female ratio were 63 years and 2.1:1, respectively. Eighty-two (82) patients (37.8%) underwent conventional CT-guided biopsies, and the other 135 patients (62.2%) C-arm CBCT virtual navigation-guided biopsies. Compared with patients undergoing C-arm CBCT virtual navigation-guided lung biopsies, patients undergoing conventional CT-guided lung biopsies showed higher needle repositioning rate, longer operation time, and higher effective dose of X-ray (52.4% vs. 6.7%, 25 min vs. 15 min, and 13.4 mSv vs. 7.6 mSv, respectively; p < 0.001, each). In total, the accurate biopsy was achieved in 215 of 217 patients (99.1%), without a significant difference between the two biopsy techniques (p = 1.000). The overall complication rates, including pneumothorax and pulmonary hemorrhage/hemoptysis, are 26.3% (57/217), with most minor complications (56/57, 98.2%). The needle repositioning was the only independent risk factor of complications with an odds ratio of 6.169 (p < 0.001). In conclusion, the C-arm CBCT virtual navigation is better in percutaneous lung biopsy than conventional CT guidance, facilitating needle positioning and reducing radiation exposure. Needle repositioning should be avoided because it brings about more biopsy-related complications.

Optimization of the Lung Biopsy Procedure: A Primer

Image-guided lung biopsy plays a very important role in the diagnosis and management of lung lesions. As a diagnostic tool, it demands a high diagnostic yield and a low complication rate. It is imperative to balance the diagnostic yield and patient safety during lung biopsies. The aim of this article is to review the standard practice guidelines of lung biopsy, to describe the techniques used to minimize the complications associated with lung biopsy, and to describe the management of complications.

December 2021 Pulmonary Case of the Month: Interstitial Lung Disease with Red Knuckles

No abstract available. Article truncated after 150 words. History of Present Illness A 56-year-old man was referred for a second opinion on recent onset of diffuse parenchymal lung disease. He had started noting mild dyspnea with yard work approximately in March 2021. His symptoms progressed over the next month with increasing shortness of breath and some fever. He presented to outside emergency department on April 17, 2021 and chest CT showing patchy ground-glass opacities with some areas of irregular consolidation (Figure 1). He was subsequently seen by an outside pulmonologist and started empirically on prednisone (50 mg/day). An outside lung biopsy had been performed which showed nonspecific interstitial pneumonitis. There was some improvement in his symptoms and his prednisone dose was reduced to 20 mg/day; however, his symptoms subsequently worsened with saturations noted to drop to 85% with any ambulation. He also had swelling of his left face and a biopsy of the parotid gland with the findings …

Idiopathic pulmonary fibrosis diagnosed concomitantly with diffuse squamous cell lung cancer on surgical lung biopsy: a case report

Background Idiopathic pulmonary fibrosis is a disease with a poor prognosis and has been associated with increased lung cancer incidence. Case presentation We report the case of a Caucasian 75-year-old woman, a former smoker, hospitalized for breathlessness with a chest computed tomography scan showing an interstitial lung disease. A surgical lung biopsy was performed, confirming a pattern of usual interstitial pneumonia but also numerous disseminated foci of well-differentiated focally invasive squamous cell carcinoma without hypermetabolic lung nodule, mass, or enlarged lymph node visualized on chest computed tomography or positron emission tomography scan. Nintedanib was started for its antifibrotic and antitumor properties, without any other antineoplastic treatment. Three years after initiation of nintedanib, clinical, functional, and computed tomography scan evaluations were stable, and there was no evidence for evolution of the squamous cell carcinoma. Conclusions Data are scarce regarding the benefit of nintedanib in patients with idiopathic pulmonary fibrosis-associated lung cancer, and it is unclear whether nintedanib could have a preventive role in lung carcinogenesis in idiopathic pulmonary fibrosis patients. This experience could help the scientific community in case of similar incidental findings.