Alberto Rebonato1, Daniele Maiettini2, Marco Andolfi3, Matthias J Fischer4, Jacopo Vannucci3, Giulio Metro5, Antonio Basile6, Michele Rossi7, Michele Duranti4. 1. Radiology Unit, Department of Surgical and Biomedical Science, Santa Maria della Misericordia University Hospital, Perugia University, Sant'Andrea delle Fratte, 06132, Perugia, Italy. rebonatoalberto@gmail.com. 2. Radiology Unit, Department of Surgical and Biomedical Science, Santa Maria della Misericordia University Hospital, Perugia University, Sant'Andrea delle Fratte, 06132, Perugia, Italy. 3. Department of Thoracic Surgery, S. Maria della Misericordia Hospital, University of Perugia Medical School, Sant'Andrea delle Fratte, 06132, Perugia, Italy. 4. Department of Radiology, S. Maria della Misericordia Hospital, University of Perugia Medical School, Sant'Andrea delle Fratte, 06132, Perugia, Italy. 5. Department of Medical Oncology, S. Maria della Misericordia Hospital, University of Perugia Medical School, Sant'Andrea delle Fratte, 06132, Perugia, Italy. 6. Department of Diagnostic and Interventional Radiology, Ospedale Ferrarotto, Via Trieste 14, 95127, Catania, Italy. 7. Department of Radiology, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy.
Abstract
PURPOSE: CT-guided percutaneous transthoracic lung needle biopsy (PLB) is an effective procedure for obtaining cyto-histological diagnoses of peripheral lesions. However, upper postero-lateral lung nodules (UPLN) may be difficult to reach using a standard intercostal either anterior or lateral approach or when the nodule is just behind a rib or scapula. We evaluated the feasibility and effectiveness of trans-scapular approach (tPLB) in these patients using large-core needles. METHODS: We retrospectively collected the data of 11 consecutive patients (mean age 74.6 years, SD 5.9) among those scheduled to undergo CT-guided PLB over the period February 2015 to February 2017. In these patients, the presence of a UPLN required a tPLB using a co-axial technique and large full-core needles (15G for the scapular piercing and 18-19G for tissue sampling). All patients were assessed by telephone at 24 h, 78 h and at an office visit at 30 days after the procedure to evaluate post-procedural pain (VAS score) and shoulder mobility. RESULTS: Ten of the eleven samples were diagnostic. No major complications were encountered. Three patients developed a pneumothorax, but none required pleural drainage. All the patients confirmed the absence of pain at 24-72 h and 30 days, reporting a VAS score less than 1, without any shoulder mobility limitation. CONCLUSION: tPLB seems to be an effective and feasible procedure, accompanied by a low risk of pneumothorax in UPLN cases.
PURPOSE: CT-guided percutaneous transthoracic lung needle biopsy (PLB) is an effective procedure for obtaining cyto-histological diagnoses of peripheral lesions. However, upper postero-lateral lung nodules (UPLN) may be difficult to reach using a standard intercostal either anterior or lateral approach or when the nodule is just behind a rib or scapula. We evaluated the feasibility and effectiveness of trans-scapular approach (tPLB) in these patients using large-core needles. METHODS: We retrospectively collected the data of 11 consecutive patients (mean age 74.6 years, SD 5.9) among those scheduled to undergo CT-guided PLB over the period February 2015 to February 2017. In these patients, the presence of a UPLN required a tPLB using a co-axial technique and large full-core needles (15G for the scapular piercing and 18-19G for tissue sampling). All patients were assessed by telephone at 24 h, 78 h and at an office visit at 30 days after the procedure to evaluate post-procedural pain (VAS score) and shoulder mobility. RESULTS: Ten of the eleven samples were diagnostic. No major complications were encountered. Three patients developed a pneumothorax, but none required pleural drainage. All the patients confirmed the absence of pain at 24-72 h and 30 days, reporting a VAS score less than 1, without any shoulder mobility limitation. CONCLUSION:tPLB seems to be an effective and feasible procedure, accompanied by a low risk of pneumothorax in UPLN cases.
Authors: Majed Refai; Marco Andolfi; Francesca Barbisan; Alberto Roncon; Gian Marco Guiducci; Francesco Xiumè; Michele Salati; Michela Tiberi; Andrea Giovagnoni; Enrico Paci Journal: Radiol Med Date: 2019-09-17 Impact factor: 3.469