Bilgisayarlı tomografi eşliğinde yapılan perkütan transtorasik biyopsinin tanı doğruluğu ve olası komplikasyonlarının değerlendirilmesi

Amaç: Bu çalışmanın amacı, bilgisayarlı tomografi kılavuzluğunda yapılan perkütan transtorasik biyopsinin (PTB) komplikasyon oranlarını, tanı doğruluğunu ve komplikasyon oluşumunu etkileyen faktörlerin değerlendirilmesidir. Gereç ve Yöntem: Bilgisayarlı tomografi eşliğinde biyopsi işlemi yapılan 153 hastayı retrospektif olarak değerlendirdik. On hastaya tekrar biyopsi yapıldığı için çalışmaya 163 PTB işlemi dahil edilmiştir.. Bulgular: Çalışmada 163 PTB işleminin 142’sinde (%87,1) tanısal sonuç sağlanmıştır. Biyopsi işlemi sırasında ve sonrasında 30 (%18,4) hastada pnömotoraks, 21 (%12,8) hastada parankimal kanama, 2 (%1,2) hastada hemoptizi gerçekleşmiştir. Pnömotoraks gelişimi ile hastanın yaşı, lezyonun nekroz içermesi, lezyon boyutu ve geçilen parankim mesafesi arasında anlamlı ilişki saptanmıştır. Parankimal kanama ile lezyon boyutu ve geçilen parankim mesafesi arasında istatistiksel olarak anlamlı ilişki saptanmıştır Sonuç: Bilgisayarlı tomografi kılavuzluğunda uygulanan PTB, toraks kitlelerinin histopatolojik tanısını elde etmede etkili, yüksek doğruluk ve düşük komplikasyon oranlarına sahip, invaziv olan cerrahi işlemlere duyulan ihtiyacı azaltan güvenilir bir yöntemdir.

Evaluation of diagnostic accuracy and possible complications of computed tomography guided percutaneous transthoracic biopsy

Purpose: The purpose of this study is to determine the diagnostic accuracy, the complication rates and the factors affecting the complications of computed tomography (CT) guided percutaneous transthoracic lung biopsy (PTB). Materials and Methods: We retrospectively evaluated 153 patients who underwent transthoracic CT-guided biopsy. Re-biopsy were performed in 10 patients so that 163 transthoracic CT-guided biopsy were included in this study. Results: Diagnostic results were achieved in 142 of 163 biopsy procedure (87.1%). During or after a biopsy procedure pneumothorax, parenchymal hemorrhage and hemoptysis were developed in 30 (18.4%), 21 (12.8%) and 2 (1.2%) patients respectively. A significant relationship was found between development of pneumothorax with the age of patient, the necrosis inclusion of the lesion, the size of the lesion and the parenchymal distance that was passed. There was a statistically significant correlation between parenchymal hemorrhage with the size of the lesion and the passed parenchymal distance. Conclusion: Computed tomography-guided PTB is a reliable method that reduces the need of invasive surgical procedures with high accuracy and low complication rates in the histopathological diagnosis of thoracic masses.

Keywords:

biopsy, computed tomography,

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1. Janssen-Heijnen MLG, Coebergh JW. The changing epidemiology of lung cancer in Europe. Lung Cancer. 2003;41:245-58.
2. Huhti E, Sutinen S, Reinila A, Poukkula A, Saloheimo M. Lung cancer in a defined geographical area: History and histological types. Thorax. 1980;35:660-7.
3. Manhire A, Charig M, Clelland C, Gleeson F, Miller R, Moss H, et al. Guidelines for radiologically guided lung biopsy. Thorax. 2003;58:920-36.
4. Zhou Q, Dong J, He J, Liu D, Tian DH, Gao S et al. The Society for Translational Medicine: indications and methods of percutaneous transthoracic needle biopsy for diagnosis of lung cancer. J Thorac Dis. 2018;10:5538-44.
5. Loubeyre P, Copercini M, Dietrich PY. Percutaneous CT-Guided multisampling core needle biopsy of thoracic lesions. AJR Am J Roentgenol. 2005;185:1294-8.
6. Veltri A, Bargellini I, Giorgi L, Almeida PAMS, Akhan O. CIRSE guidelines on percutaneous needle biopsy (PNB). Cardiovasc Intervent Radiol. 2017;40:1501-13.
7. Laurent F, Montaudon M, Latrabe V, Bégueret H.Percutaneous biopsy in lung cancer. Eur J Radiol. 2003;45:60-8.
8. Cox JE, Chiles C, McManus CM, Aquino SL, Choplin RH. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Radiology. 1999;212:165-8.
9. Zhao Y, Wang X, Wang Y, Zhu Z. Logistic regression analysis and a risk prediction model of pneumothorax after CT-guided needle biopsy. J Thorac Dis. 2017;9:4750-7.
10. Li Y, Dua Y, Yang HF, Yu JH, Xu XX. CT-guided percutaneous core needle biopsy for small (<20 mm) pulmonary lesions. Clin Radiol. 2013;68:43-8.
11. Webb WR, Higgins CB. Thoracic Imaging, Pulmonary and Cardiovasculary Radiology. 2nd ed. Philadelphia: Lippincott Williams & Wilkins. 2011.
12. Kazerooni EA, Lim FT, Mikhail A, Martinez FJ. Risk of pneumothorax in CT-guided transthoracic needle aspiration biopsy of the lung. Radiology. 1996;198:371-5.
13. Topal U, Berkman YM. Effect of needle tract bleeding on occurrence of pneumothorax after transthoracic needle biopsy. Eur J Radiol. 2005;53:495-9.
14. Yeow KM, Su IH, Pan KT, Tsay PK, Lui KW, Cheung YC et al. Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies. Chest. 2004;126:748-54.
15. Geraghty PR, Kee ST, McFarlane G, Razavi MK, Sze DY, Dake MD. CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. Radiology. 2003;229:475-81.
16. Topal U, Ediz B. Transthoracic needle biopsy: factors effecting risk of pneumothorax. Eur J Radiol. 2003;48:263–7.
17. Heerink WJ, de Bock GH, de Jonge GJ, Groen HJ, Vliegenthart R, Oudkerk M. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol. 2017;27:138-48.
18. Miller KS, Fish GB, Stanely JH, Schabel SI. Prediction of pneumothorax rate in percutaneous needle aspiration of the lung. Chest. 1988;93:742-5.
19. Anderson JM, Murchison J, Patel D. CT-guided Lung Biopsy: factors influencing diagnostic yield and complication rate. Clin Radiol. 2003;58:791-7.
20. Aktas AR, Gozlek E, Yazkan R, Yilmaz O, Kayan M, Demirtas H et al. Transthoracic biopsy of lung masses: Non technical factors affecting complication occurrence. Thorac cancer. 2015;6:151-8.
21. Ohno Y, Hatabu H, Takenaka D, Higashino T, Watanabe H, Ohbayashi C et al. CT-guided transthoracic needle aspiration biopsy of small (≤ 20 mm) solitary pulmonary nodules. AJR Am J Roentgenol. 2003;180:1665-9.
22. Kuban JD, Tam AL, Huang SY, Ensor JE, Philip AS, Chen GJ, et al. The effect of needle gauge on the risk of pneumothorax and chest tube placement after percutaneous computed tomographic (CT)-guided lung biopsy. Cardiovasc Intervent Radiol. 2015;38:1595-602.
23. Guo Z, Shi H, Li W, Lin D, Wang C, Liu C et al. Chinese multidisciplinary expert consensus: Guidelines on percutaneous transthoracic needle biopsy. Thorac Cancer. 2018;9:1530-43.
24. Gümüştaş S, Çiftçi E. Akciğer kanseri tanısında perkütan biyopsiler. Trd Sem. 2014; 2:354-63.
25. Satoh S, Ohdama S, Matsubara O, Okochi Y, Tanaka R, Kimula Y. CT-guided automated cutting needle biopsy by a combined method for accurate specific diagnosis of focal lung lesions. Radiat Med. 2005;23:30-6.
26. Khan MF, Straub R, Moghaddam SR, Maataoui A, Gurung J, Wagner TO et al. Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy. Eur Radiol. 2008;18:1356-63.
27. Loh SE, Wu DD, Venkatesh SK, Ong CK, Liu E, Seto KY et al. CT-guided thoracic biopsy: evaluating diagnostic yield and complications. Ann Acad Med Singap. 2013;42:285-90.
28. Tsukada H, Satou T, Iwashima A, Souma T. Diagnostic accuracy of CT-guided automated needle biopsy of lung nodules. AJR Am J Roentgenol. 2000;175:239-43.
29. Lee KH, Lim KY, Suh YJ, Hur J, Han DH, Kang MJ et al. Diagnostic accuracy of percutaneous transthoracic needle lung biopsies: a multicenter study. Korean J Radiol. 2019;20:1300-10.