Lung Cancer |

Quantitative Emphysema Score as a Predictor of Morbidity in Transthoracic Needle Aspiration Biopsy FREE TO VIEW

Nicole Gonzales; David Wang; Jon-Erik Holty; Ware Kuschner; Philippe Raffy; Paul Laeseke; Rajesh Shah; arthur sung; Ryan Van Wert
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Stanford University, Stanford, CA

Chest. 2015;148(4_MeetingAbstracts):587A. doi:10.1378/chest.2280739
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SESSION TITLE: Lung Cancer Treatment Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: CT-guided percutaneous transthoracic needle aspiration (TTNA) biopsy for evaluation of lung nodules has a high diagnostic yield; however, the procedure is associated with a high pneumothorax (PTX) rate compared to bronchoscopic biopsy techniques. While the presence of emphysema on CT is an independent risk factor for pneumothorax, the assessment of emphysema has been largely subjective, limiting its utility as a predictor of morbidity. In the present study, lung quantitative imaging software was utilized to precisely quantify the degree of emphysema in patients undergoing TTNA.

METHODS: Patient and procedure data from sequential TTNA procedures performed at a Veterans Affairs facility between September 2011- February 2014 were retrospectively reviewed. CT scans performed within 6 months of the TTNA were analyzed using lung quantitative imaging software (Apollo®, VIDA Diagnostics, Coralville, IA). Quantitative emphysema score (defined as the percentage of lung parenchyma < -950 HU) was calculated for the entire lung and by lobe, and compared using a Student's t-test.

RESULTS: Preliminary analysis was performed at the time of abstract preparation on 13 male patients with a mean age of 66 years. Of these, 3 patients sustained a pneumothorax (PTX) and 10 patients did not. The mean nodule-to-pleura distance was 16.6mm and 32.0mm, the mean needle angle was 82° and 76°, and the mean needle distance was 86mm and 95mm in the PTX and non-PTX groups, respectively. The global emphysema score in the PTX group was 11.3% and in the non-PTX group 0.7% (p=0.01) The emphysema score in the PTX group for the lobe containing the nodule was 7.6%; in the non-PTX group, 0.78% (p=0.48)

CONCLUSIONS: This preliminary analysis suggests a correlation between quantitative emphysema score and the risk of PTX after TTNA.

CLINICAL IMPLICATIONS: With the advent of widespread screening for lung cancer, the need for tissue sampling of lung nodules will increase dramatically. Quantitative assessment of emphysema may be an important tool in determining risk of morbidity in patients for whom TTNA is being considered for the diagnosis of lung cancer. Such a tool may aid clinical decisionmaking in choosing the most appropriate diagnostic procedure, with a goal of personalizing the diagnostic pathway of lung cancer for each patient.

DISCLOSURE: Philippe Raffy: Employee: VIDA Diagnostic Employee Performing Image Analysis The following authors have nothing to disclose: Nicole Gonzales, David Wang, Jon-Erik Holty, Ware Kuschner, Paul Laeseke, Rajesh Shah, arthur sung, Ryan Van Wert

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