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CT Versus CT in Biopsy Site Selection
months was 72.3% and 50% for Group A; 83.3% and 67.6% for Group B.
Abstract No. 306
CONCLUSION: Covered-Viabil stents are safe and effective for palliative treatment of malignant biliary disease and seem to offer a better 6 and 12-month patency rate compared with uncovered Wallstents.
Percutaneous CT-Guided Transthoracic Needle Biopsy of Lung Lesions with Focul Pure Glound-Glass Opacity. D. Inoue, H. Gobara, K. Kato, T. Kurose, T. Hiraki, H. Fujiwara, J. Sakurai, H. Mimura, S. Kanazawa; Department of Radiology, Okayama University Medical School, Okayama, Japan
Non-vascular Interventions: Biopsy/ Diagnostic Fluid Aspiration
PURPOSE: To report the efficacy and acurracy for percutaneous CT-guided transthoracic needle biopsy of lung lesions with focal pure ground-glass opacity (GGO).
Abstract No. 305 The Value of PET/CT Versus CT in Biopsy Site Selection. B. Beauchene,1 R. Korn,2 J. Neil,2 R. Newbold,2 A. Irving,2 D. Cox;1 1Midwestern University, Glendale, AZ; 2Scottsdale Medical Imaging Ltd., Scottsdale, AZ PURPOSE: The objective of this retrospective study was to determine the added value of PET/CT upon the decision making process of the interventional radiologist when determining the most appropriate site and/or lesion to biopsy using minimally invasive percutaneous tissue sampling techniques for cancer diagnosis. MATERIALS AND METHODS: Forty eight patients were selected for retrospective review if they had undergone a tissue biopsy sampling between 01/01/2003 and 12/31/ 2005, had a PET/CT, and diagnostic CT performed within 30 days of each other. The images obtained were deidentified according to HIPAA and IRB requirements to protect patients’ private health information. The CT and PET/CT fused images for each patient were interpreted by two interventional radiologists (IR) with a combined average 12.5 years experience. The IR were blinded to patient history, diagnosis, and reports. During image interpretation, efforts were made to prevent recall of previously analyzed scans by presenting each study in random order (within each modality) with all patient identifiers removed. The IR were randomly shown 48 CTs and 48 PET/CTs. Data recorded included lesion location, shape, composition, size, and metabolic activity. Of the recorded lesions, the IR were asked to select one lesion for biopsy and explain the reasons for their selection.
CONCLUSION: PET/CT gives an interventional radiologist a more precise visual of where each lesion is located, which lesion is the most metabolically active, easiest to access, and safest to biopsy. The addition of PET/CT has a significant impact on biopsy site selection compared to CT, which has ultimately led to improved patient safety and management.
RESULTS: Tissue specimens could be obtained in 75(98.7%) lesions. The histological diagnosis was adenocarcinoma in 52 (69.3%) lesions, “atypical cells” in 9 (12.0%), and benign condition in 12 (16.0%). According to the diagnosis, All adenocarcinoma cases but one were treated by surgery (n⫽44), radiofrequency ablation (n⫽6), and chemotherapy (n⫽1). One patient denied receiving surgery. Eight of 9 “atypical cells” lesions were resected surgically. The diagnoses of surgical specimen were all adenocarcinoma. Among 12 benign cases, surgical resections were performed in 4 cases, RFA in 1, clinical course observation in 4, and lost to follow up in 3. One of 4 surgically resected lesion was diagnosed adenocarcinoma. The follow-up CT image (6-37 months after biopsy) showed unchanged in 5 lesions, including one adenocarcinoma and 2 “atypical cells”. The sensitivity and specificity for diagnosis of malignancy were 98.3% and 100%, respectively. Complications were occurred in 25 of 76 procedures, including pneumothoraces in 24, and asymptomatic air embolism in 1. However, none of pneumothorax was required chest tube placement. Alveolar hemorrhages were occurred in 75 cases. Due to alveolar hemorrhage, the lesions became invisible after previous biopsy procedure. Thereby, only one specimen could be obtained in 19 procedures. CONCLUSION: CT-guided transthoracic needle biopsy of lung lesions with focal pure GGO is safe and feasible. Once alveolar hemorrhage masks the lesion, the biopsy procedure may cease. It is important to make an effort to obtain a specimen at the first puncture. Abstract No. 307
POSTER SESSIONS
RESULTS: The interventional radiologists identified a total combined average of 106.5 lesions on CT and 119.5 lesions on PET/CT. PET/CT improved diagnosis of lesions by identifying on average 45.5 additional lesions on CT. A different lesion was selected for biopsy on PET/CT 49% of the time (CI 38-40%) compared to CT as the reference study. At least one out of five times (20.9%) metabolic activity was considered the most important factor for determining lesion selection if PET/CT was introduced into the decision making process.
MATERIALS AND METHODS: From April 2000 to April 2007, CT-guided transthoracic needle biopsies were performed in 1048 lesions at our institution. Of these, Seventysix lesions showed focal pure GGO. The biopsy procedure was performed under CT-fluoroscopic guidance using 20Gcoaxial cutting needle. The mean lesion diameter was 11.7 mm (range 5-20).
Anterograde Tract Seeding with Core and FNA Biosy Needles: An In-Vitro Model. S.H. Roberts,1 D.H. Oliver,2 M.L. Censullo;2 1M.D. Anderson Cancer Center, Houston, TX; 2University of Texas Health Science Center, Houston, Houston, TX PURPOSE: To evaluate the potential for anterograde tract seeding during biopsy using a variety of commonly-used biopsy needles. MATERIALS AND METHODS: Using a 5% agarose gel matrix, wells filled with cultured HeLa adenocarcinoma cells suspended in both 0.5% agarose and standard storebought gelatin. Visually guided needle biopsies were performed with 5 different needle combinations (20g FNA, 22g FNA, coaxial 20g side cutting core with and without spring loaded firing, and 22g FNA with an echogenic coated tip) in S113
Abstract No. 306
CONCLUSION: Covered-Viabil stents are safe and effective for palliative treatment of malignant biliary disease and seem to offer a better 6 and 12-month patency rate compared with uncovered Wallstents.
Percutaneous CT-Guided Transthoracic Needle Biopsy of Lung Lesions with Focul Pure Glound-Glass Opacity. D. Inoue, H. Gobara, K. Kato, T. Kurose, T. Hiraki, H. Fujiwara, J. Sakurai, H. Mimura, S. Kanazawa; Department of Radiology, Okayama University Medical School, Okayama, Japan
Non-vascular Interventions: Biopsy/ Diagnostic Fluid Aspiration
PURPOSE: To report the efficacy and acurracy for percutaneous CT-guided transthoracic needle biopsy of lung lesions with focal pure ground-glass opacity (GGO).
Abstract No. 305 The Value of PET/CT Versus CT in Biopsy Site Selection. B. Beauchene,1 R. Korn,2 J. Neil,2 R. Newbold,2 A. Irving,2 D. Cox;1 1Midwestern University, Glendale, AZ; 2Scottsdale Medical Imaging Ltd., Scottsdale, AZ PURPOSE: The objective of this retrospective study was to determine the added value of PET/CT upon the decision making process of the interventional radiologist when determining the most appropriate site and/or lesion to biopsy using minimally invasive percutaneous tissue sampling techniques for cancer diagnosis. MATERIALS AND METHODS: Forty eight patients were selected for retrospective review if they had undergone a tissue biopsy sampling between 01/01/2003 and 12/31/ 2005, had a PET/CT, and diagnostic CT performed within 30 days of each other. The images obtained were deidentified according to HIPAA and IRB requirements to protect patients’ private health information. The CT and PET/CT fused images for each patient were interpreted by two interventional radiologists (IR) with a combined average 12.5 years experience. The IR were blinded to patient history, diagnosis, and reports. During image interpretation, efforts were made to prevent recall of previously analyzed scans by presenting each study in random order (within each modality) with all patient identifiers removed. The IR were randomly shown 48 CTs and 48 PET/CTs. Data recorded included lesion location, shape, composition, size, and metabolic activity. Of the recorded lesions, the IR were asked to select one lesion for biopsy and explain the reasons for their selection.
CONCLUSION: PET/CT gives an interventional radiologist a more precise visual of where each lesion is located, which lesion is the most metabolically active, easiest to access, and safest to biopsy. The addition of PET/CT has a significant impact on biopsy site selection compared to CT, which has ultimately led to improved patient safety and management.
RESULTS: Tissue specimens could be obtained in 75(98.7%) lesions. The histological diagnosis was adenocarcinoma in 52 (69.3%) lesions, “atypical cells” in 9 (12.0%), and benign condition in 12 (16.0%). According to the diagnosis, All adenocarcinoma cases but one were treated by surgery (n⫽44), radiofrequency ablation (n⫽6), and chemotherapy (n⫽1). One patient denied receiving surgery. Eight of 9 “atypical cells” lesions were resected surgically. The diagnoses of surgical specimen were all adenocarcinoma. Among 12 benign cases, surgical resections were performed in 4 cases, RFA in 1, clinical course observation in 4, and lost to follow up in 3. One of 4 surgically resected lesion was diagnosed adenocarcinoma. The follow-up CT image (6-37 months after biopsy) showed unchanged in 5 lesions, including one adenocarcinoma and 2 “atypical cells”. The sensitivity and specificity for diagnosis of malignancy were 98.3% and 100%, respectively. Complications were occurred in 25 of 76 procedures, including pneumothoraces in 24, and asymptomatic air embolism in 1. However, none of pneumothorax was required chest tube placement. Alveolar hemorrhages were occurred in 75 cases. Due to alveolar hemorrhage, the lesions became invisible after previous biopsy procedure. Thereby, only one specimen could be obtained in 19 procedures. CONCLUSION: CT-guided transthoracic needle biopsy of lung lesions with focal pure GGO is safe and feasible. Once alveolar hemorrhage masks the lesion, the biopsy procedure may cease. It is important to make an effort to obtain a specimen at the first puncture. Abstract No. 307
POSTER SESSIONS
RESULTS: The interventional radiologists identified a total combined average of 106.5 lesions on CT and 119.5 lesions on PET/CT. PET/CT improved diagnosis of lesions by identifying on average 45.5 additional lesions on CT. A different lesion was selected for biopsy on PET/CT 49% of the time (CI 38-40%) compared to CT as the reference study. At least one out of five times (20.9%) metabolic activity was considered the most important factor for determining lesion selection if PET/CT was introduced into the decision making process.
MATERIALS AND METHODS: From April 2000 to April 2007, CT-guided transthoracic needle biopsies were performed in 1048 lesions at our institution. Of these, Seventysix lesions showed focal pure GGO. The biopsy procedure was performed under CT-fluoroscopic guidance using 20Gcoaxial cutting needle. The mean lesion diameter was 11.7 mm (range 5-20).
Anterograde Tract Seeding with Core and FNA Biosy Needles: An In-Vitro Model. S.H. Roberts,1 D.H. Oliver,2 M.L. Censullo;2 1M.D. Anderson Cancer Center, Houston, TX; 2University of Texas Health Science Center, Houston, Houston, TX PURPOSE: To evaluate the potential for anterograde tract seeding during biopsy using a variety of commonly-used biopsy needles. MATERIALS AND METHODS: Using a 5% agarose gel matrix, wells filled with cultured HeLa adenocarcinoma cells suspended in both 0.5% agarose and standard storebought gelatin. Visually guided needle biopsies were performed with 5 different needle combinations (20g FNA, 22g FNA, coaxial 20g side cutting core with and without spring loaded firing, and 22g FNA with an echogenic coated tip) in S113