C-Arm Cone-Beam CT-guided Transthoracic Needle Biopsy.

According to a study published in Radiology, by Lee SM et al from Seoul, South Korea they report on a retrospective analysis of percutaneous biopsies of lung lesions performed on 1108 patients in the period between January 2009 and December 2011.  The gender distribution in this study was 633 males and 475 females  with a mean age of 62.4 years.  

The diagnostic performance, complication rate, influencing factors and patient radiation exposure, of the 1116 lesions (mean size 2.7 cm) that were biopsied with an 18-gauge co-axial needle were evaluated.    Of the nodules biopsied 766 were malignant (66.4%), 323 were benign (28%) and 59 were indeterminate (5.1%).  The sensitivity, specificity and accuracy for the diagnosis of malignancy were 95.7%, 100% and 97% respectively.  There were five technical failures and 33 biopsies were false negative.  Lesions in the lower lobes, multiple passages and emphysema were risk factors.  Pneumothorax occurred in in 196 (17%) and hemoptysis in 80 (7%) patients.  Mean estimated radiation dose during the procedure was 7.3 mSv +/- 4.1.   

The authors conclude that Cone-beam CT-guided biopsy is an accurate and safe means to diagnose lung lesions. 

Lee SM, Park CM, Lee KH, Young E: Transthoracic Needle Biopsy of Lung Nodules: Clinical Experience in 1108 Patients.  Radiology, Vol 271(1), April 2014: 291-300

DOI: http://dx.doi.org/10.1148/radiol.13131265

Breast Conservation Therapy provides Better Survival for Early Stage Breast Cancer

Reseach by Agarwal S, et al published in JAMASurgery reports on an analysis of 132 149 patients who were followed between the years 1998 and 2008.  

Breast conservation therapy (lumpectomy and radiation therapy) was used to treat 70% of patients, mastectomy alone was used to treat 27% of patients, and mastectomy with radiation was used to treat 3% of patients. The 5-year breast cancer–specific survival rates of patients who underwent BCT, a mastectomy alone, or a mastectomy with radiation were 97%, 94%, and 90%, respectively (P < .001); the 10-year breast cancer–specific survival rates were 94%, 90%, and 83%, respectively (P < .001). Multivariate analysis showed that women undergoing BCT had a higher survival rate than those undergoing mastectomy alone (hazard ratio, 1.31; P < .001) or mastectomy with radiation (hazard ratio, 1.47; P < .001). 

The authors conclude that patients who underwent BCT versus mastectomy alone or mastectomy and radiation therapy for early stage invasive ductal cancer- defined as having a tumor size of 4 cm or smaller and 3 or less positive lymph nodes- have higher breast cancer specific survival.

Agarwal S, Pappas L, Neumayer M et al; Effect of Breast Conservation Therapy vs Mastectomy on Disease-Specific Survival for Early-Stage Breast Cancer.  JAMA Surg. Published online January 15, 2014

doi:10.1001/jamasurg.2013.3049