Caroline Dahlqvist

Diagnostic Accuracy and Safety of CT-Guided Percutaneous Transthoracic Needle Biopsies: 14-Gauge versus 22-Gauge Needles.

PURPOSE To compare the diagnostic accuracy and safety of a 14-gauge core needle versus a 22-gauge fine needle in the evaluation of thoracic lesions by CT-guided percutaneous transthoracic needle biopsy (TTNB). MATERIALS AND METHODS Medical charts of all patients who underwent CT-guided percutaneous transthoracic core-needle biopsies (CNBs) with a 14-gauge Spirotome device (99 patients, 102 procedures) and fine-needle biopsies (FNBs) with a 22-gauge Rotex needle (92 patients, 102 procedures) between 2007 and 2013 at a single academic institution were retrospectively reviewed. Variables that could influence diagnostic accuracy and safety were collected. RESULTS The overall and cancer-specific diagnostic accuracy rates were 90% and 94%, respectively, with CNB, versus 82% and 89% with FNB. Precise cancer type/subtype was provided by 97% of CNBs versus 65% of FNBs (P < .001). In patients with lung cancer considered for targeted therapy, biomarker analyses were feasible in 80% of CNBs versus 0% of FNBs (P < .001). The rate of pneumothorax was significantly higher with CNB versus FNB (31% vs 19%; P = .004), but chest tube insertion rates were similar (10% vs 11%, respectively). Major bleeding complications occurred in 1% of CNBs versus 2% of FNBs and were associated with one death in the CNB group. CONCLUSIONS Percutaneous transthoracic CNB with a 14-gauge Spirotome needle provided better characterization of cancer lesions and allowed biomarker analyses without a significant increase in major procedural complications.

New bifurcated silicone stent for the treatment of posttransplant bronchus intermedius stenosis: new silicone stent in posttransplant stenosis.

In both cases, the stents were positioned on the primary right carina, with the upper arm allowing ventilation and drainage of the upper lobe and simultaneously preventing migration. However, the dimensions and angulation of the upper lobe arm do not always fi t into the right bronchial tree. According to good preliminary results in patients with cancer, 1 , 4 we chose to use the new Oki stent in two patients after lung transplantation. Grade 4 5 bronchus intermedius stenoses developed in a 62-year-old woman and a 55-year-old woman 3 and 2 months, respectively, after bilateral lung transplantation for COPD. Before the Oki stent placement, the fi rst patient underwent fi ve rigid bronchoscopy procedures for dilatation, and the second underwent one procedure. Stenting was performed according to the pulling method, 1 , 4 allowing correct positioning in both cases. Unfortunately, the stent in the second patient was removed accidentally during a fl exible bronchoscopy procedure 1 month later. Given the reoccurrence of the stenosis, a second Oki stent with a longer upper lobe arm was placed to decrease the risk of migration. Both patients experienced immediate symptom relief after stent positioning. Preoperative FEV 1 was 550 mL (33% predicted) for the fi rst patient and 740 mL (33% predicted) for the second, and it increased to 1,050 mL (48% predicted) and 1,500 mL (67% predicted), respectively, 1 week after the intervention. Five months after the procedure, no complications were observed for the fi rst patient. Eight weeks after the second Oki stent placement, the second patient presented with sputum retention and a minimal granulomatous reaction at the distal extremity of the stent. On the basis of this preliminary experience, the new bifurcated silicone stent seems to be a promising and well-tolerated alternative for the treatment of posttransplant bronchus intermedius stenosis.

Fully Covered Metallic Stents for the Treatment of Benign Airway Stenosis.

Introduction. We herein report our experience with new fully covered self-expanding metallic stents in the setting of inoperable recurrent benign tracheobronchial stenosis. Methods. Between May 2010 and July 2014, 21 Micro-Tech® FC-SEMS (Nanjing Co., Republic of Korea) were placed in our hospital in 16 patients for inoperable, recurrent (after dilatation), and symptomatic benign airway stenosis. Their medical files were retrospectively reviewed in December 2014, with focus on stents tolerance and durability data. Results. Twenty-one stents were inserted: 13 for posttransplant left main bronchus anastomotic stricture, seven for postintubation tracheal stenosis, and one for postlobectomy anastomotic stricture. Positioning was easy for all of them. Stents were in place for a mean duration of 282 days. The most common complications were granulation tissue development (35%), migration (30%), and sputum retention (15%). Fifty-five % of the stents (11/20) had to be removed because of various complications, without difficulty for all of them. None of the patients had life-threatening complications. Conclusion. Micro-Tech FC-SEMS were easy to position and to remove. While the rate of complications requiring stent removal was significant, no life-threatening complication occurred. Further studies are needed to better define their efficacy and safety in the treatment of benign airway disease.

Corrigendum to “Fully Covered Metallic Stents for the Treatment of Benign Airway Stenosis”

[This corrects the article DOI: 10.1155/2016/8085216.].