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Title: Freehand Two-Step CT-Guided Brain Tumor Biopsy: A Fast and Effective Interventional Procedure in Selected Patients

Abstract

Purpose. To evaluate the efficacy and safety of CT-guided needle biopsy of brain lesions without a stereotactic device, and to determine the best possible indications for this technique. Methods. From February 2001 to February 2004, 20 patients (12 men, 8 women; age 61-82 years) underwent CT-guided brain lesion biopsy. The procedure started with a brain CT scan for lesion localization and for selection of the inlet for needle insertion. The patient was then transported to the operating room where cranioanatrisis was performed. Subsequently, the biopsy was performed under CT guidance using a 14G brain biopsy needle with a blind smooth end and lateral holes. At the end of the biopsy, the field was checked for possible complications with a CT scan. Results. Histopathologic results were: brain tumor in 16 patients (80%), inflammatory process in 3 (15%), and no conclusive diagnosis in 1 (5%). A repeat of the process was required in 2 patients. A minor complication of local hematoma was found in 1 patient (5%). There were no deaths or other serious complications.Conclusion. CT-guided biopsy is a reliable method for histopathologic diagnosis of brain lesions in selected cases. It is a simple, fast, effective, low-cost procedure with minimal complications, indicatedmore » especially for superficial and large tumors.« less

Authors:
; ; ; ; ;  [1]
  1. 'Korgialeneio-Benakeio', Hellenic Red-Cross Hospital of Athens, Radiology Department (Greece)
Publication Date:
OSTI Identifier:
21091256
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 29; Journal Issue: 2; Other Information: DOI: 10.1007/s00270-005-0015-2; Copyright (c) 2006 Springer Science+Business Media, Inc.; www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOMEDICAL RADIOGRAPHY; BIOPSY; BRAIN; COMPUTERIZED TOMOGRAPHY; COST; DEATH; DIAGNOSIS; HEMATOMAS; IMAGE PROCESSING; INFLAMMATION; NEOPLASMS; PATIENTS

Citation Formats

Thanos, Loukas, E-mail: loutharad@yahoo.com, Mylona, Sofia, Galani, Panagiota, Kalioras, Vasilios, Pomoni, Maria, and Batakis, Nikolaos. Freehand Two-Step CT-Guided Brain Tumor Biopsy: A Fast and Effective Interventional Procedure in Selected Patients. United States: N. p., 2006. Web. doi:10.1007/S00270-005-0015-2.
Thanos, Loukas, E-mail: loutharad@yahoo.com, Mylona, Sofia, Galani, Panagiota, Kalioras, Vasilios, Pomoni, Maria, & Batakis, Nikolaos. Freehand Two-Step CT-Guided Brain Tumor Biopsy: A Fast and Effective Interventional Procedure in Selected Patients. United States. doi:10.1007/S00270-005-0015-2.
Thanos, Loukas, E-mail: loutharad@yahoo.com, Mylona, Sofia, Galani, Panagiota, Kalioras, Vasilios, Pomoni, Maria, and Batakis, Nikolaos. Sat . "Freehand Two-Step CT-Guided Brain Tumor Biopsy: A Fast and Effective Interventional Procedure in Selected Patients". United States. doi:10.1007/S00270-005-0015-2.
@article{osti_21091256,
title = {Freehand Two-Step CT-Guided Brain Tumor Biopsy: A Fast and Effective Interventional Procedure in Selected Patients},
author = {Thanos, Loukas, E-mail: loutharad@yahoo.com and Mylona, Sofia and Galani, Panagiota and Kalioras, Vasilios and Pomoni, Maria and Batakis, Nikolaos},
abstractNote = {Purpose. To evaluate the efficacy and safety of CT-guided needle biopsy of brain lesions without a stereotactic device, and to determine the best possible indications for this technique. Methods. From February 2001 to February 2004, 20 patients (12 men, 8 women; age 61-82 years) underwent CT-guided brain lesion biopsy. The procedure started with a brain CT scan for lesion localization and for selection of the inlet for needle insertion. The patient was then transported to the operating room where cranioanatrisis was performed. Subsequently, the biopsy was performed under CT guidance using a 14G brain biopsy needle with a blind smooth end and lateral holes. At the end of the biopsy, the field was checked for possible complications with a CT scan. Results. Histopathologic results were: brain tumor in 16 patients (80%), inflammatory process in 3 (15%), and no conclusive diagnosis in 1 (5%). A repeat of the process was required in 2 patients. A minor complication of local hematoma was found in 1 patient (5%). There were no deaths or other serious complications.Conclusion. CT-guided biopsy is a reliable method for histopathologic diagnosis of brain lesions in selected cases. It is a simple, fast, effective, low-cost procedure with minimal complications, indicated especially for superficial and large tumors.},
doi = {10.1007/S00270-005-0015-2},
journal = {Cardiovascular and Interventional Radiology},
number = 2,
volume = 29,
place = {United States},
year = {Sat Apr 15 00:00:00 EDT 2006},
month = {Sat Apr 15 00:00:00 EDT 2006}
}
  • Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by small benign tumors of mesenchymal origin also known as phosphaturic mesenchymal tumors mixed connective tissue variant. Excellent prognosis is expected with eradication of the culprit tumor. These small tumors are notoriously difficult to localize with conventional imaging studies; this often leads to an extensive work up and prolonged morbidity. We report a patient with clinical diagnosis of TIO whose culprit tumor was localized with Ga-68 DOTATOC PET/CT and MRI. Biopsy and cryoablation were performed under Ga-68 DOTATOC PET/CT guidance. Autoradiography of the biopsy specimen was performed and showed in situmore » correlation between Ga-68 DOTATOC uptake and histopathology with millimeter resolution.« less
  • Percutaneous biopsy of upper cervical vertebrae is challenging due to the various critical structures in the location and often requires difficult trajectory such as transoral or paramaxillary approaches. The purpose of this manuscript is to illustrate the utility of head rotation in creating a potential space for direct percutaneous access to C3 vertebral body for safe biopsy.
  • PurposeTo assess the scope and determining risk factors related to the development of pneumothorax throughout CT-guided biopsy of pulmonary lesions in coaxial and non-coaxial techniques and the outcome of its management.Materials and MethodsThe study included CT-guided percutaneous lung biopsies in 650 consecutive patients (407 males, 243 females; mean age 54.6 years, SD 5.2) from November 2008 to June 2013 in a retrospective design. Patients were classified according to lung biopsy technique into coaxial group (318 lesions) and non-coaxial group (332 lesions). Exclusion criteria for biopsy were lesions <5 mm in diameter, uncorrectable coagulopathy, positive-pressure ventilation, severe respiratory compromise, pulmonary arterial hypertension, ormore » refusal of the procedure. Risk factors related to the occurrence of pneumothorax were classified into: (a) Technical risk factors, (b) patient-related risk factors, and (c) lesion-associated risk factors. Radiological assessments were performed by two radiologists in consensus. Mann–Whitney U test and Fisher’s exact tests were used for statistical analysis. p values <0.05 were considered statistically significant.ResultsThe incidence of pneumothorax complicating CT-guided lung biopsy was less in the non-coaxial group (23.2 %, 77 out of 332) than the coaxial group (27 %, 86 out of 318). However, the difference in incidence between both groups was statistically insignificant (p = 0.14). Significant risk factors for the development of pneumothorax in both groups were emphysema (p < 0.001 in both groups), traversing a fissure with the biopsy needle (p value 0.005 in non-coaxial group and 0.001 in coaxial group), small lesion, less than 2 cm in diameter (p value of 0.02 in both groups), location of the lesion in the basal or mid sections of the lung (p = 0.003 and <0.001 in non-coaxial and coaxial groups, respectively), and increased needle track path within the lung tissue of more than 2.5 cm (p = 0.01 in both groups). The incidence of pneumothorax in the non-coaxial group was significantly correlated to the number of specimens obtained (p = 0.006). This factor was statistically insignificant in the coaxial group (p = 0.45). The biopsy yield was more diagnostic and conclusive in the coaxial group in comparison to the non-coaxial group (p = 0.008). Simultaneous incidence of pneumothorax and pulmonary hemorrhage was 27.3 % (21/77) in non-coaxial group and in 30.2 % (26/86) in coaxial group. Conservative management was sufficient for treatment of 91 out of 101 patients of pneumothorax in both groups (90.1 %). Manual evacuation of pneumothorax was efficient in 44/51 patients (86.3 %) in both groups and intercostal chest tube was applied after failure of manual evacuation (7 patients: 13.7 %), from which one patient developed a persistent air leakage necessitating pleurodesis.ConclusionPneumothorax complicating CT-guided core biopsy of pulmonary lesions, showed the insignificant difference between coaxial and non-coaxial techniques. However, both techniques have the same significant risk factors including small and basal lesions, increased lesion’s depth from pleural surface, and increased length of aerated lung parenchyma crossed by biopsy needle and passing through pulmonary fissures in the needle tract.« less
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