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OBJECTIVES: To analyze computed tomography (CT) characteristics predictive for diagnostic accuracy and pneumothorax in CT fluoroscopy-guided transthoracic biopsy (CTF-TTB) of lung lesions using non-coaxial biopsy needle technique. METHODS: Retrospectively 274 lung lesion biopsies with confirmed histology were included in our study. CTF-TTB was done using an 18-gauge non-coaxial cutting needle. Diagnostic accuracy rates were calculated per lesion size and CT and procedural characteristics were evaluated for their predictive value regarding diagnostic accuracy and development of pneumothorax (maximal nodule diameter, distance to pleura, location per lung segment, nodule composition, benign versus malignant histology, and number of specimens). RESULTS: Overall diagnostic accuracy of CTF-TTB was high (93%). Diagnostic accuracy for lesions ≤10 mm was 81%. Maximal nodule diameter was the only predictive CT characteristic for diagnostic success (p = 0.03). Pneumothorax occurred in 27%. Distance of lesion to pleura was the only risk factor for pneumothorax (p < 0.00001). Pneumothorax rates were significantly lower in subpleural lesions (14%) compared to those located 1-10 mm (47%), 10-20 mm (33%), and >20 mm from pleura (29%). CONCLUSIONS: High diagnostic accuracy rates were achieved with CTF-TTB using non-coaxial biopsy technique, even for lesions ≤10 mm. Pneumothorax rates were comparable with other studies. Lesion size was the only predictive CT characteristic for diagnostic accuracy. Distance to pleura was the only risk factor for pneumothorax. ispartof: JOURNAL OF THE BELGIAN SOCIETY OF RADIOLOGY vol:105 issue:1 ispartof: location:England status: published

The aim of this study was to evaluate the risk of pneumothorax and need for chest tube insertion in CT-guided lung biopsies and identify predictors focusing on pulmonary emphysema determined with quantitative computed tomography. To that end, we retrospectively analysed the incidence of pneumothorax and chest tube insertion in 371 CT-guided lung biopsies with respect to the quantitative emphysema score determined with the density mask technique. Other possible impact factors considered were lesion diameter, length of biopsy pathway within the lung parenchyma, lung lobe, needle size, puncture technique, patient positioning and interventionalist’s level of experience. Quantitative emphysema scores of the lung were significantly higher in patients who developed instant pneumothorax (27%, p

Pulmonary arterial hypertension (PAH) is a progressive and lethal pulmonary vascular disease (PVD). Although in recent years outcome has improved by new treatments that delay disease progression, a cure has not yet been achieved. In PAH associated with congenital heart disease (CHD), remodeling of the pulmonary vasculature reaches an irreversible phenotype similar to all forms of end-stage PAH. In PAH-CHD, however, also an early stage is recognised, which can be completely reversible. This reversible phase has never been recognised in other forms of PAH, most likely because these patients are only diagnosed once advanced disease has developed. We propose that the clinical model of PAH-CHD, with an early reversible and advanced irreversible stage, offers unique opportunities to study pathophysiological and molecular mechanisms that orchestrate the transition from reversible medial hypertrophy into irreversible plexiform lesions. Comprehension of these mechanisms is not only pivotal in clinical assessment of disease progression and operability of patients with PAH-CHD; specific targeting of these mechanisms may also lead to pharmacological interventions that transform ‘irreversible’ plexiform lesions into a reversible PVD: one that is amenable for a cure. In recent years, significant steps have been made in the strive to ‘reverse the irreversible’. This review provides an overview of current clinical and experimental knowledge on the reversibility of PAH, focussing on flow-associated mechanisms, and the near-future potential to advance this field.

BACKGROUND: Pulmonary arterial hypertension (PAH) is hallmarked by the development of neointimal lesions. The transcription factor Egr-1 seems to play a critical role in neointimal formation in experimental PAH and was identified as a putative target for intervention. In this study we investigated whether Egr-1 is also associated with neointimal-type vascular remodeling in different forms of human PAH or pulmonary hypertension.METHODS: Using immunohistochemistry, we studied Egr-1 expression specifically in a wide morphologic spectrum of pulmonary arteries in the lung tissue of 72 patients with different forms and stages of PAH, specifically idiopathic PAH (n = 18), advanced-stage congenital heart disease associated PAH (PAH-CHD) (n = 21), early-stage PAH-CHD (n = 19) and non-neointimal hypoxic pulmonary hypertension (PH) (n = 4), and controls (n = 10).RESULTS: In PAH patients, pulmonary vascular expression of Egr-1 protein was abundant, whereas it was sporadic in non-neointimal (hypoxic) PH patients and controls. In PAH-CHD, protein expression was more pronounced in patients with advanced vascular lesions compared to those with less advanced lesions, such as medial hypertrophy.CONCLUSIONS: Pulmonary vascular Egr-1 expression, is significantly increased in patients with PAH, appears specifically associated with neointimal-type vascular remodeling, and correlates with disease progression. These data translate the critical role of Egr-1 in the development of experimental PAH to human pulmonary vascular disease forms. (C) 2016 International Society for Heart and Lung Transplantation. All rights reserved.

The use of biopsies to establish a diagnostic is frequently needed during the investigation of lung diseases. To this end, methods such as bronchoscopy, image-guided percutaneous biopsy or even surgical methods may be employed. Nevertheless, it is not always possible to establish a definitive diagnosis even after analysis of the material obtained by biopsies. Explanations for this might be due to the sampling area of the biopsy, the pathological issues, the particularities collecting material method, and the characteristics of the disease itself. Thereby learning the diagnostic accuracy of each biopsy method becomes an essential requirement for a better indication of the procedure. It is critical to understand the risk-benefit inherent in each indicated method. This research aimed to determine the diagnostic accuracy of two methods of obtaining lung biopsies employed in a University Hospital. To reach this objective, the pathological results of lung biopsies performed at the Pathology Department of the University Hospital of Santa Maria S (HUSM), obtained from the Education for Information System (EIS) were analyzed. The following variables were collected: age, sex, date of biopsy, the biopsy method, and their pathological diagnosis. All patients undergoing lung biopsy procedures at HUSM in the period between 2003 and 2013 were considered eligible. In total, 1547 pathological reports were identified as being from lung biopsies of that period. However, 93 reports were found not eligible. After applying the inclusion criteria, 122 pathological reports were the selected for statistical analysis. Of these, 21 were from biopsy procedures guided by computed tomography (CT), 45 from endobronchial biopsy and other 56 from surgical procedures, the latter, regarded as the gold standard for assessment of accuracy. The accuracy of biopsy performed by the endobronchial method and CT-guided were measured by area under the Receiver Operator Characteristic (ROC) curve. The endobronchial biopsy had an area under the curve of 0.645. The sensitivity and specificity calculated to this method were respectively 43% and 85%. The accuracy of CT-guided biopsy assessed by the area the area under the curve was 0.681. For this method, the calculated sensitivity was 61%, and the specificity was 75%. Although the evaluation of the accuracy was obtained solely by the reports of the pathological analysis, the area under the curve was over 0.6 in both methods. In conclusion, both biopsies methods had reasonable accuracy and are therefore important tools in the diagnostic evaluation of lung diseases. Eventualmente na investigação de doenças pulmonares ocorre a necessidade da realização de biópsias para elucidação diagnóstica. Para este fim, métodos como a broncoscopia, biópsias percutâneas guiadas por métodos de imagem ou mesmo cirurgia podem ser empregados. Entretanto nem sempre é possível estabelecer um diagnóstico definitivo mesmo após análise do material obtido por biópsias. Explicações para este fato podem ser atribuídas ao caráter de amostragem da biópsia, a dificuldade de interpretação patológica da amostra obtida, às particularidades de cada método de coleta de material, às características da lesão em questão, entre outras causas. Desse modo, obter o conhecimento da acurácia diagnóstica de cada método de biópsia torna-se requisito essencial para uma melhor indicação do procedimento, considerando o risco-benefício inerente ao método indicado. Esta pesquisa visou definir a acurácia diagnóstica de dois métodos de obtenção de material pulmonar empregados em um hospital universitário. Para chegar a esse objetivo foram analisados resultados anatomopatológicos de biópsias pulmonares que deram entrada no serviço de patologia do Hospital Universitário de Santa Maria (HUSM), obtidos através do Sistema de Informações para o Ensino (SIE). Foram coletadas as seguintes variáveis: idade, sexo, data da biópsia, método da biópsia e seus respectivos diagnósticos patológicos. Foram objeto de pesquisa os dados coletados de exames anatomopatológicos de pacientes submetidos à procedimentos de biópsia pulmonar no HUSM no período compreendido entre os anos de 2003 e 2013. Foram analisados inicialmente, 1547 laudos anatomopatológicos enquadrados como sendo provenientes de biópsias pulmonares do referido período, porém 93 laudos foram considerados não elegíveis. Após aplicação dos critérios de inclusão, 122 laudos anatomopatológicos serviram de base para as análises estatísticas. Destes, 21 eram provenientes de procedimentos de biópsia pulmonar percutânea transtorácica (BPPT) guiada por tomografia computadorizada (TC), 45 provenientes de biópsia endobrônquica e outros 56 provenientes de procedimentos cirúrgicos, sendo estes últimos, os considerados como padrão-ouro para aferição da acurácia. A acurácia da biópsia realizada por método endobrônquico, aferida através de curva ROC (receiver operator characteristic) teve como área sob a curva o valor calculado de 0,645. A sensibilidade e a especificidade calculadas para esse método foram respectivamente, de 43% e 85%. A acurácia da BPPT guiada por TC, aferida também através de curva ROC teve como resultado uma área sob a curva calculada em 0,681. Para esse método a sensibilidade calculada foi igual a 61% e a especificidade igual a 75%. Conclui-se que os resultados encontrados podem ser considerados razoáveis já que foram proporcionados unicamente pela análise de resultados de laudos anatomopatológicos provenientes destas biópsias, e que a acurácia de tais métodos foi satisfatória, conforme avaliação da curva ROC. Os dois métodos constituem-se, portanto, em ferramentas importantes na avaliação diagnóstica de patologias pulmonares.