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The American Journal of Case Reports Jun 2024BACKGROUND Lung cancer is the most common malignant neoplasm diagnosed worldwide. Early diagnosis and treatment are of great importance for patient's prognosis. A wide...
BACKGROUND Lung cancer is the most common malignant neoplasm diagnosed worldwide. Early diagnosis and treatment are of great importance for patient's prognosis. A wide variety of pulmonary conditions display clinical and radiological presentation similar to that of lung cancer, and the awareness of their existence can help in making correct diagnoses. CASE REPORT This article presents a description of 4 patients with an insidious type of lesions mimicking pulmonary carcinomas. The first patient was referred to Department with a tumor-like lesion in the right lung. After CT of the chest and core-needle biopsy, the lesion turned out to be an ectopic thyroid tissue. The second patient reported a dry cough and weight loss. A lung nodule mass was revealed in chest CT and the patient was diagnosed with pulmonary tuberculoma. The remaining 2 patients, despite the suspicion of lung cancer, were subsequently diagnosed with a post-traumatic pleural hematoma and diffuse large B cell lymphoma. CONCLUSIONS Low-dose computed tomography of the chest plays a significant role in the diagnosis of newly detected lesions in the lungs. However, due to the similarity of the image of cancer to that of other diseases, the ultimate diagnosis should be based on the interpretation of full imaging diagnostic tests, clinical presentation, and histopathological examination of the material obtained from the lesion. Analysis of cases enables us to expand our understanding of the diseases that need to be considered in differential diagnosis of a patient with a detected tumor-like lesion in the lungs.
Topics: Humans; Diagnosis, Differential; Lung Neoplasms; Male; Middle Aged; Tomography, X-Ray Computed; Female; Aged; Lung Diseases; Adult; Tuberculosis, Pulmonary
PubMed: 38877695
DOI: 10.12659/AJCR.943798 -
Therapeutic Advances in Respiratory... 2024Robotic-assisted bronchoscopy (RAB) was recently added to the armamentarium of tools used in sampling peripheral lung nodules. Protocols and guidelines have since been...
Robotic-assisted bronchoscopy (RAB) was recently added to the armamentarium of tools used in sampling peripheral lung nodules. Protocols and guidelines have since been published advocating use of large oral artificial airways, use of confirmatory technologies such as radial endobronchial ultrasound (R-EBUS), and preferably limiting sampling to pulmonary parenchymal lesions. We present three clinical cases where RAB was used unconventionally to sample pulmonary nodules in unusual locations and in patients with challenging airway anatomy. In case 1, we introduced the ion catheter through a nasal airway in a patient with trismus. In case 2, we established a diagnosis by sampling a station 5 lymph node, and in case 3, we sampled a lesion located behind an airway stump from previous thoracic surgery. All three patients would have presented significant challenges for alternative biopsy modalities such as CT-guided needle biopsy or video-assisted thoracic surgery.
Topics: Humans; Bronchoscopy; Robotic Surgical Procedures; Lung Neoplasms; Male; Middle Aged; Aged; Female; Tomography, X-Ray Computed
PubMed: 38877690
DOI: 10.1177/17534666241259369 -
Journal of Cardiothoracic Surgery Jun 2024Pneumothorax is the most frequent complication after CT-guided percutaneous transthoracic lung biopsy (CT-PTLB). Many studies reported that injection of autologous blood... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pneumothorax is the most frequent complication after CT-guided percutaneous transthoracic lung biopsy (CT-PTLB). Many studies reported that injection of autologous blood patch (ABP) during biopsy needle withdrawal could reduce the pneumothorax and chest tube insertion rate after CT-PTLB, but the result is debatable. The aim of this systematic review and meta-analysis is to synthesize evidence regarding the efficacy of ABP procedure in patients receiving CT-PTLB.
METHODS
Eligible studies were searched in Pubmed, Embase and Web of Science databases. The inclusion criteria were studies that assessed the relationship between ABP and the pneumothorax and/or chest tube insertion rate after CT-PTLB. Subgroup analyses according to study type, emphysema status and ABP technique applied were also conducted. Odds ratio (OR) with 95% confidence interval (CI) were calculated to examine the risk association.
RESULTS
A total of 10 studies including 3874 patients were qualified for analysis. Our analysis suggested that ABP reduced the pneumothorax (incidence: 20.0% vs. 27.9%, OR = 0.67, 95% CI = 0.48-0.66, P < 0.001) and chest tube insertion rate (incidence: 4.0% vs. 8.0%, OR = 0.47, 95% CI = 0.34-0.65, P < 0.001) after CT-PTLB. Subgroup analysis according to study type (RCT or retrospective study), emphysema status (with or without emphysema), and ABP technique applied (clotted or non-clotted ABP) were also performed and we found ABP reduced the pneumothorax and chest tube insertion rate in all subgroups.
CONCLUSIONS
Our study indicated that the use of ABP was effective technique in reducing the pneumothorax and chest tube insertion rate after CT-PTLB.
Topics: Pneumothorax; Humans; Tomography, X-Ray Computed; Image-Guided Biopsy; Lung; Blood Transfusion, Autologous; Chest Tubes
PubMed: 38877547
DOI: 10.1186/s13019-024-02781-0 -
BMC Surgery Jun 2024Guidelines for thyroid surgery have evolved to reflect advances in medical knowledge and decrease the overdiagnosis of low-risk thyroid cancer. Our goal was to analyze...
BACKGROUND
Guidelines for thyroid surgery have evolved to reflect advances in medical knowledge and decrease the overdiagnosis of low-risk thyroid cancer. Our goal was to analyze the change made in operative thyroid management and the impact on thyroid cancer diagnosis.
BACKGROUND
Guidelines for thyroid surgery have evolved to reflect advances in medical knowledge and decrease overdiagnosis of low risk thyroid cancer. Our goal was to study the evolution, over a long period, of pre- and postoperative management and the influence on histological cancer diagnosis and, more particularly, microcancer.
METHODS
In this retrospective cohort study, we included 891 consecutive patients who underwent thyroid surgery between 2007 and 2020.
RESULTS
Respectively 305, 290 and 266 patients underwent surgery over the 3 periods of 2007-2010, 2011-2015 and 2016-2020. In all three periods, women represented approximately 70% of the population, and the mean age was 54 years old (range: 67). Most surgeries (90%) involved total thyroidectomies. Over the study period, the proportion of preoperative fine needle aspiration (FNA) increased from 13 to 55%, p < 0,01. Cancer was found in a total of 116 patients: 35 (11%) patients between 2007 and 2010, 50 (17%) between 2011 and 2015 and 32 (12%) between 2016 and 2020 (p = 0.08). For all 3 periods, papillary thyroid cancer (PTC) was the most prevalent, at approximately 80%. The proportion of thyroid cancer > T1a increased significantly from 37% (2011-2015 period) to 81% (2016-2020 period), p = 0.001. Patients treated with radioiodine remained relatively stable (approximately 60%) but were more frequently treated with a low dose of radioiodine (p < 0.01) and recombinant human TSH (p < 0.01). Operative thyroid weight decreased over time in all but the low-risk T1a PTC cases.
CONCLUSIONS
Over a period of 15 years and according to the evolution of recommendations, the care of patients who underwent thyroid surgery changed with the increased use of preoperative FNA. This change came with a decrease in low-risk T1a PTC.
Topics: Humans; Retrospective Studies; Female; Middle Aged; Male; Thyroidectomy; Aged; Thyroid Neoplasms; Belgium; Biopsy, Fine-Needle; Practice Guidelines as Topic; Adult
PubMed: 38877435
DOI: 10.1186/s12893-024-02471-7 -
Breast Disease 2024An 85-year-old Chinese lady presented with a 5-day history of a painless left breast lump. There was no fever, nipple discharge, or history of trauma. She had a past...
An 85-year-old Chinese lady presented with a 5-day history of a painless left breast lump. There was no fever, nipple discharge, or history of trauma. She had a past medical history of atrial fibrillation that was managed with an oral anticoagulant. Mammography demonstrated a dense mass in the upper outer quadrant of the left breast. Ultrasound showed an irregular, heterogeneous 4.7 cm lesion containing debris and cystic spaces with raised peripheral vascularity at the 2 o'clock position, 3 cm from nipple. No internal vascularity was detected. This was managed as a haematoma and rivaroxaban was withheld. Follow-up imaging 3-weeks later showed persistence of the lesion. Bedside needle aspiration yielded haemoserous fluid with immediate reduction in size of the lesion. However, 2 weeks after aspiration, there was recurrence of the 'haematoma'. Multidisciplinary review of the clinical history, examination and imaging was sought, and biopsy of the irregularly thickened areas with vascularity along the periphery of the lesion was recommended. Vacuum-assisted biopsy was performed, and histology returned as metaplastic carcinoma. A recurring 'haematoma' should always prompt a search for a secondary cause, with features such as irregular thickened walls and papillary/nodular components requiring further evaluation with biopsy for histopathological correlation.
Topics: Humans; Female; Hematoma; Breast Neoplasms; Aged, 80 and over; Diagnosis, Differential; Mammography; Metaplasia; Recurrence
PubMed: 38875024
DOI: 10.3233/BD-240006 -
Journal of the Korean Society of... May 2024This study investigated whether the respiratory phase during pleural puncture in CT-guided percutaneous transthoracic needle biopsy (PTNB) affects complications.
PURPOSE
This study investigated whether the respiratory phase during pleural puncture in CT-guided percutaneous transthoracic needle biopsy (PTNB) affects complications.
MATERIALS AND METHODS
We conducted a retrospective review of 477 lung biopsy CT scans performed during free breathing. The respiratory phases during pleural puncture were determined based on the table position of the targeted nodule using CT scans obtained during free breathing. We compared the rates of complications among the inspiratory, mid-, and expiratory respiratory phases. Logistic regression analysis was performed to control confounding factors associated with pneumothorax.
RESULTS
Among the 477 procedures, pleural puncture was performed during the expiratory phase in 227 (47.6%), during the mid-phase in 108 (22.6%), and during the inspiratory phase in 142 (29.8%). The incidence of pneumothorax was significantly lower in the expiratory puncture group (40/227, 17.6%; = 0.035) and significantly higher in the mid-phase puncture group (31/108, 28.7%; = 0.048). After controlling for confounding factors, expiratory-phase puncture was found to be an independent protective factor against pneumothorax (odds ratio = 0.571; 95% confidence interval = 0.360-0.906; = 0.017).
CONCLUSION
Our findings suggest that pleural puncture during the expiratory phase may reduce the risk of pneumothorax during image guided PTNB.
PubMed: 38873383
DOI: 10.3348/jksr.2023.0093 -
Journal of the Korean Society of... May 2024
PubMed: 38873377
DOI: 10.3348/jksr.2024.0070 -
Alternative Therapies in Health and... Jun 2024To evaluate the efficacy of ultrasound-guided Mammotome (MMT) vacuum-assisted biopsy (VAB) for the qualitative diagnosis of breast nodules smaller than 5 cm in diameter.
OBJECTIVE
To evaluate the efficacy of ultrasound-guided Mammotome (MMT) vacuum-assisted biopsy (VAB) for the qualitative diagnosis of breast nodules smaller than 5 cm in diameter.
METHODS
A retrospective analysis was conducted on clinical data from 102 patients with breast nodules between November 2020 and November 2023. Patients were divided into two groups: the core needle biopsy (CNB) group (n=56) and the MMT-VAB group (n=46). The MMT-VAB group underwent biopsy using the Mammotome SCM23K breast biopsy system, while the CNB group used a disposable biopsy needle. Surgical pathology results were used as the gold standard. Sensitivity, specificity, and accuracy of the two methods in diagnosing benign and malignant breast nodules were compared. Complications, such as bleeding, hematoma, subcutaneous bruising, and skin damage, were recorded and analyzed.
RESULTS
No significant differences in clinical data were observed between the CNB and MMT-VAB groups (P > .05). The sensitivity, specificity, and accuracy for the CNB group were 72.41%, 88.89%, and 80.36%, respectively, with a kappa value of 0.609. For the MMT-VAB group, sensitivity was 95.00%, specificity 92.31%, and accuracy 93.48%, with a kappa value of 0.868. The detection rate of malignant lesions was significantly higher in the MMT-VAB group (95.00%) compared to the CNB group (72.41%) (χ2=4.027, P = .045). No significant difference in complication rates was found between the two groups (χ2=3.608, P = .058).
CONCLUSION
Ultrasound-guided MMT-VAB offers higher diagnostic accuracy for breast nodules smaller than 5 cm compared to CNB, making it a valuable tool for early diagnosis. Future research should focus on enhancing MMT-VAB technology, understanding factors influencing diagnostic accuracy, expanding clinical applications, and evaluating long-term outcomes to support clinical decision-making.
PubMed: 38870513
DOI: No ID Found -
Alternative Therapies in Health and... Jun 2024This study aims to evaluate the efficiency of ultrasound-guided core needle biopsy (CNB) and fine needle aspiration biopsy (FNA) in the diagnosis of breast cancer with...
OBJECTIVE
This study aims to evaluate the efficiency of ultrasound-guided core needle biopsy (CNB) and fine needle aspiration biopsy (FNA) in the diagnosis of breast cancer with internal mammary node (IMN) metastasis. The focus is on specimen satisfaction, puncture tolerance, and classification accuracy.
METHODS
A retrospective analysis was conducted on breast cancer patients (n=106) who underwent ultrasound-guided IMN biopsy at our hospital from March 2020 to March 2023. Patients were divided into CNB and FNA groups based on the biopsy technique. The study analyzed one-time sampling satisfaction, overall specimen satisfaction, and post-puncture pain score (VAS), comparing the effectiveness of both methods in IMN diagnosis and classification.
RESULTS
In the CNB and FNA groups, 3 and 1 cases respectively had unsatisfactory specimens, later excluded in pathological examinations. The FNA group demonstrated higher one-time sampling satisfaction than the CNB group (P < .05), but no significant difference in overall specimen satisfaction was observed (P > .05). Among 102 patients with satisfactory specimens, 96 showed positive IMN metastasis. The kappa statistics measuring the consistency between biopsy methods and actual IMN (Invasive Mammary Carcinoma) metastasis show a value of 0.637 for CNB (Core Needle Biopsy) and 0.769 for FNA (Fine Needle Aspiration), indicating a higher consistency for FNA. Different IMN types also varied in kappa values. Post-puncture VAS scores were higher in the CNB group (P < .05), with no significant difference in total complication rates between the groups (P > .05).
CONCLUSION
Ultrasound-guided CNB and FNA both demonstrate good overall specimen satisfaction and equivalent safety. FNA. However, FNA showed superior performance in one-time specimen satisfaction, diagnostic consistency for IMN metastasis, and patient tolerance during the procedure.
PubMed: 38870512
DOI: No ID Found -
Spine Surgery and Related Research May 2024
PubMed: 38868790
DOI: 10.22603/ssrr.2023-0259