Radiology

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Browsing Radiology by Author "Alwan, Amir(MD, Associate prof.)"

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    A Prospective Study on Diagnostic Yield, Complication Rate and Associated Factors of Computed Tomography (CT) Guided Transthoracic Needle Biopsy in Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia.
    (Addis Ababa University, 2019-10) Girma, AbdulKerim; Alwan, Amir(MD, Associate prof.); Gissila, Azmera(MD, Associate prof.)
    Introduction:Percutaneous image-guided transthoracic needle biopsy is a safe, minimally invasive, accepted, easy and accurate procedure that provides useful diagnostic information and avoids more invasive and expensive exploratory surgeries especially in medically treatable or unresectable cases. Computed tomography (CT) guided transthoracic needle biopsy involves the insertion of a needle under the guidance of a CT scan to a mediastinal, pleural or pulmonary lesion from which a tissue specimen is taken for cytological evaluation. Any solid or cystic lesion between chest wall and mediastinum can be biopsied percutaneously by a needle provided that it is not accessible by a bronchoscopy. Although it is a safe and minimally invasive procedure, CT guided a transthoracic needle biopsy (TNB) can have some complications. Although it is a well-accepted procedure worldwide with determined accuracy and complication rate our study was intended to specify this hospital experience, to settle a base for an institutional guidelines for selecting fit patients for CT guided transthoracic needle biopsy, for directing ways for rapid detection of complications and management if any occurs. Objective:To determine the diagnostic yield, complication rate and associated factors of CT guided transthoracic needle biopsy in TikurAnbessa specialized hospital, Addis Ababa University, Addis Ababa, Ethiopia. Methodology:An institutional-based prospective study was conducted on all patients for whom CT guided TNB was done for mediastinal, pleural, pulmonary or multi-compartmental mass lesions and have pathology result from July 2018 to July 2019 G.C. The collected data wereprocessed and analyzed using IBM SPSS statistics software version 25 and it is presented by statements, figures, graphs, and tables. Result:CT guided transthoracic biopsy was done on 57 males (56.4%) and 44 females (43.6%) whose mean age was 49.12 years. The location of the lesions was lung (72.28%), mediastinal (12.87%), pleural (10.89%), and multi-compartmental (3.96%). Average of 3 pleural punctures were required for adequate lesion access. A minimum of 3 and a maximum of 8 scans (mean 4.8) were taken during the procedures with a mean DLP of 159.3 mG cm. The mean time required to perform biopsy was 24.8 minutes. The study found that the cooperative patients had statistically significant lower number of scans and short procedure duration than uncooperative patients. The conclusive rate of the procedure was 76.2%. Adenocarcinoma was the most common pathologic result of biopsied lung lesions whereas Thymoma and adenocarcinoma infiltrate were the most common findings in mediastinal and pleural lesions. This study didn’t find statistically significant differences between the conclusive and non-conclusive patient groups in terms of age, sex, lesion characteristics or technical factors. Among the 101 biopsies, 20.8% had complications of which the most common was pneumothorax 12.9% followed by alveolar hemorrhage (5%). Complications had a strong positive correlation with the traversed aerated lung and negative correlation with the mean size of the lesion along the planned trajectory. Conclusion and Recommendation:CT-guided percutaneous transthoracic needle biopsy can be performed easily and safely with patient comfort, high conclusive rate, and few associated complications. Lesion size and distance of traversed aerated lung tissue are correlated with complications but no associated factor was found with diagnostic yield. However, it is possible that larger sample size and correlation with the surgical outcome and follow-up imaging could show more subtle trends. The procedure can be done with low dose protocols and shorter duration provided that the patient position selection and line of trajectory are settled at the pre-procedural time.