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.
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2019-10
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Addis Ababa University
Abstract
Introduction:Percutaneous image-guided transthoracic needle biopsy is a safe, minimally invasive,accepted, easy and accurate procedure that provides useful diagnostic information and avoids moreinvasive and expensive exploratory surgeries especially in medically treatable or unresectable cases.Computed tomography (CT) guided transthoracic needle biopsy involves the insertion of a needle underthe guidance of a CT scan to a mediastinal, pleural or pulmonary lesion from which a tissue specimen istaken for cytological evaluation. Any solid or cystic lesion between chest wall and mediastinum can bebiopsied percutaneously by a needle provided that it is not accessible by a bronchoscopy. Although it is asafe and minimally invasive procedure, CT guided a transthoracic needle biopsy (TNB) can have somecomplications. Although it is a well-accepted procedure worldwide with determined accuracy andcomplication rate our study was intended to specify this hospital experience, to settle a base for aninstitutional guidelines for selecting fit patients for CT guided transthoracic needle biopsy, for directingways 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 CTguided 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 were processed 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 procedureswith 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 negativecorrelation 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 complicationsbut 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 positionselection and line of trajectory are settled at the pre-procedural time.
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CT guided, transthoracic needle, biopsy