Clinical value of CT-guided biopsy of small (≤1.5 cm) suspicious lung nodules: Diagnostic accuracy, molecular characterization and long-term clinical outcomes

Tamrazi, Anobel; Sundaresan, Srividya; Parvizi, Amin; Eller, Andrea R.; Fujii, Juanita; Shaheen, Zayna; Campbell, A. N.

doi:10.1016/j.ctarc.2022.100626

Cited by 4 publications

(3 citation statements)

References 29 publications

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“…Further con-siderations are recommended when sampling bilateral pulmonary nodules. It is important to mention pneumothorax risk ranges from 25.3% to 27.2% [4,21] with CT transthoracic biopsy (CTTB), which is to date the standard diagnostic intervention for PPNs. Yu Lee-Mateus et al [6] compared ssRAB to CTTB, and while diagnostic yield was similar between these methods (87.6% vs. 88.4, respectively), pneumothorax was significantly higher with CTTB when compared to ssRAB (17% vs. 4.4%, p = 0.002).…”

Section: Discussionmentioning

confidence: 99%

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Shape-Sensing Robotic-Assisted Bronchoscopy in the Multiple Pulmonary Nodule Diagnosis during a Single Anesthetic Event

Fernandez-Bussy,

Garza-Salas,

Barrios-Ruiz

et al. 2024

Respiration

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Introduction: The widespread use of Computed tomography (CT) as a screening tool for early lung cancer has increased detection of pulmonary lesions. It is common to encounter patients with more than one peripheral pulmonary nodule (PPN) of uncertain etiology. Shape-sensing robotic-assisted bronchoscopy (ssRAB) emerges as a potential alternative to biopsy multiple PPN, in addition to mediastinal staging in single anesthetic procedure. Methods: Retrospective review of 22 patients who underwent ssRAB for evaluation of two or more PPN, between November 2021 and April 2023 at Mayo Clinic Florida, US. Results: A total of 46 PPN were biopsied in 22 patients. All lesions were ≤ 2 cm with a maximum and minimum median lesion size of 1.40cm and 1.05cm, respectively. Diagnostic yield was 84.8% (n=39) and target reach was 91.3% (n=42). Most lesions were in the upper lobes, a solid pattern was found in 78.3% (n=36), bronchus sign was present in 82.6% of cases (n=38), 54.4% (n=25) were malignant nodules, and 30.4% (n=14) were benign. Fourteen patients had one malignant lesion out of two or more nodules sampled and ten patients had a malignant diagnosis for all sampled lesions. The complication rate was 9% (n=2) and pneumothorax rate was 4.5% (n=1). Conclusion: This study is, to our knowledge, the first to assess the use and safety of ssRAB for diagnosis of multiple PPN in a single anesthetic event. This procedure will mainly impact management decisions and subsequently shorten the time from diagnosis to treatment.

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Section: Discussionmentioning

confidence: 99%

“…Generally, CT-guided samples of different PPNs are obtained in separate interventions and on different days to rule out delayed pneumothorax [3] before proceeding to the next nodule. Few attempts have been performed at two interventions on the same day [4], as this can potentially increase the rate of complications.…”

Section: Introductionmentioning

confidence: 99%

Shape-Sensing Robotic-Assisted Bronchoscopy in the Multiple Pulmonary Nodule Diagnosis during a Single Anesthetic Event

Fernandez-Bussy,

Garza-Salas,

Barrios-Ruiz

et al. 2024

Respiration

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“…Radiologically guided core biopsies are common procedures in daily hospital practice. CT scan-guided and fine-needle aspiration biopsy offer high accuracy in approaching pulmonary lesions, with high diagnostic performance and low rates of secondary effects, even in small nodules [ 38 , 39 , 40 ]. Their usefulness lies in the rapid confirmation of cancer diagnosis, primary or metastatic, offering tissue material for molecular analysis.…”

Section: Diagnostic Walks On the Tight Ropementioning

confidence: 99%

Revisiting Pulmonary Sclerosing Pneumocytoma

Manini,

Vezzini,

Conte

et al. 2024

Clinics and Practice

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Pulmonary sclerosing pneumocytoma (PSP) is a quite rare tumor outside Eastern countries. This rarity, together with a wide histological appearance, makes its correct identification a diagnostic challenge for pathologists under the microscope. Historically, PSP was considered a vascular-derived neoplasm (sclerosing hemangioma), but its immunohistochemical profile clearly supports its epithelial origin. No specific molecular fingerprint has been detected so far. This short narrative revisits the clinical, histological, immunohistochemical, and molecular aspects of this tumor, paying special attention to some controversial points still not well clarified, i.e., clinical aggressiveness and metastatic spread, multifocality, the supposed development of sarcomatoid change in a subset of cases, and tumor associations with lung adenocarcinoma and/or well-differentiated neuroendocrine hyperplasia/tumors. The specific diagnostic difficulties on fine-needle aspiration cytology/biopsy and perioperative frozen sections are also highlighted. Finally, a teaching case of tumor concurrence of lung adenocarcinoma, neuroendocrine lesions, and PSP, paradigmatic of tumor association in this context, is also presented.

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Economic Evaluation of a Novel Lung Cancer Diagnostic in a Population of Patients with a Positive Low-Dose Computed Tomography Result

Morris,

Habib,

Do Valle

et al. 2024

Journal of Health Economics and Outcomes Research

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Background: Early detection of lung cancer is crucial for improving patient outcomes. Although advances in diagnostic technologies have significantly enhanced the ability to identify lung cancer in earlier stages, there are still limitations. The alarming rate of false positives has resulted in unnecessary utilization of medical resources and increased risk of adverse events from invasive procedures. Consequently, there is a critical need for advanced diagnostics after an initial low-dose computed tomography (LDCT) scan. Objectives: This study evaluated the potential cost savings for US payers of CyPath® Lung, a novel diagnostic tool utilizing flow cytometry and machine learning for the early detection of lung cancer, in patients with positive LDCT scans with indeterminate pulmonary nodules (IPNs) ranging from 6 to 29 mm. Methods: A cost offset model was developed to evaluate the net expected savings associated with the use of CyPath® Lung relative to the current standard of care for individuals whose IPNs range from 6 to 29 mm. Perspectives from both Medicare and private payers in a US setting are included, with a 1-year time horizon. Cost calculations included procedure expenses, complication costs, and diagnostic assessment costs per patient. Primary outcomes of this analysis include cost savings per cohort and cost savings per patient. Results: Our analysis showed positive cost savings from a private payer’s perspective, with expected savings of $895 202 311 per cohort and $6460 per patient, across all patients. Scenario analysis resulted in cost savings of $890 829 889 per cohort, and $6429 per patient. Similarly, savings of $378 689 020 per cohort or $2733 per patient were yielded for Medicare payers, across all patients. In addition, scenario analysis accounting for false negative patients from a Medicare payer perspective yielded savings of $376 902 203 per cohort and $2720 per patient. Discussion: The results suggest substantial cost savings, primarily due to reductions in follow-up diagnostic assessments and procedures, and highlight the importance of accurate diagnostic tools in reducing unnecessary healthcare expenditures. Conclusion: CyPath® Lung utilization yields savings for private and Medicare payers relative to the current standard of care in a US setting for individuals with 6 to 20 mm IPNs.

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Clinical value of CT-guided biopsy of small (≤1.5 cm) suspicious lung nodules: Diagnostic accuracy, molecular characterization and long-term clinical outcomes

Cited by 4 publications

References 29 publications

Shape-Sensing Robotic-Assisted Bronchoscopy in the Multiple Pulmonary Nodule Diagnosis during a Single Anesthetic Event

Shape-Sensing Robotic-Assisted Bronchoscopy in the Multiple Pulmonary Nodule Diagnosis during a Single Anesthetic Event

Revisiting Pulmonary Sclerosing Pneumocytoma

Economic Evaluation of a Novel Lung Cancer Diagnostic in a Population of Patients with a Positive Low-Dose Computed Tomography Result

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