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Computer tomography guided lung biopsy using interactive breath-hold control: a randomized study.

ABSTRACT: BACKGROUND:Interactive breath-hold control (IBC) may improve the accuracy and decrease the complication rate of computed tomography (CT)-guided lung biopsy, but this presumption has not been proven in a randomized study. METHODS:Patients admitted for CT-guided lung biopsy were randomized to biopsy either with (N=201) or without (N=206) IBC. Biopsy accuracy, procedure time, radiation, and complications were compared in the two groups. Predictors for pneumothorax were analyzed. RESULTS:Procedures performed with the use of IBC (N=130) did not show higher biopsy accuracy (P=0.979) but were associated with a higher risk of pneumothorax (P=0.022) compared to procedures without the use of IBC (N=171). Overall, 50% of the biopsies were malignant, 13% were benign, and 33% were inconclusive (4% missing). Long needle time (P=0.037) and small nodule size (P=0.001) were predictors of pneumothorax. CONCLUSIONS:The use of IBC for CT-guided lung biopsy was not an advantage for unselected patients in our care, since it did not improve the biopsy accuracy and the risk of pneumothorax was increased.

SUBMITTER: Ashraf H

PROVIDER: S-EPMC5497083 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Computer tomography guided lung biopsy using interactive breath-hold control: a randomized study.

Ashraf Haseem H Krag-Andersen Shella S Naqibullah Matiullah M Minddal Valentina V Nørgaard Annette A Naur Therese Maria Henriette TMH Myschetzky Peter Sand PS Clementsen Paul Frost PF

Annals of translational medicine 20170601 12

<h4>Background</h4>Interactive breath-hold control (IBC) may improve the accuracy and decrease the complication rate of computed tomography (CT)-guided lung biopsy, but this presumption has not been proven in a randomized study.<h4>Methods</h4>Patients admitted for CT-guided lung biopsy were randomized to biopsy either with (N=201) or without (N=206) IBC. Biopsy accuracy, procedure time, radiation, and complications were compared in the two groups. Predictors for pneumothorax were analyzed.<h4>R ...[more]

PMID: 28706921

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Project description:Breath-hold divers (BHD) experience repeated bouts of severe hypoxia and hypercapnia with large increases in blood pressure. However, the impact of long-term breath-hold diving on cerebrovascular control remains poorly understood. The ability of cerebral blood vessels to respond rapidly to changes in blood pressure represents the property of dynamic autoregulation. The current investigation tested the hypothesis that breath-hold diving impairs dynamic autoregulation to a transient hypotensive stimulus. Seventeen BHD (3 women, 11?±?9 yr of diving) and 15 healthy controls (2 women) completed two or three repeated sit-to-stand trials during spontaneous breathing and poikilocapnic conditions. Heart rate (HR), finger arterial blood pressure (BP), and cerebral blood flow velocity (BFV) from the right middle cerebral artery were measured continuously with three-lead electrocardiography, finger photoplethysmography, and transcranial Doppler ultrasonography, respectively. End-tidal carbon dioxide partial pressure was measured with a gas analyzer. Offline, an index of cerebrovascular resistance (CVRi) was calculated as the quotient of mean BP and BFV. The rate of the drop in CVRi relative to the change in BP provided the rate of regulation [RoR; (?CVRi/?T)/?BP]. The BHD demonstrated slower RoR than controls (P ? 0.001, d?=?1.4). Underlying the reduced RoR in BHD was a longer time to reach nadir CVRi compared with controls (P = 0.004, d?=?1.1). In concert with the longer CVRi response, the time to reach peak BFV following standing was longer in BHD than controls (P = 0.01, d?=?0.9). The data suggest impaired dynamic autoregulatory mechanisms to hypotension in BHD. NEW & NOTEWORTHY Impairments in dynamic cerebral autoregulation to hypotension are associated with breath-hold diving. Although weakened autoregulation was observed acutely in this group during apneic stress, we are the first to report on chronic adaptations in cerebral autoregulation. Impaired vasomotor responses underlie the reduced rate of regulation, wherein breath-hold divers demonstrate a prolonged dilatory response to transient hypotension. The slower cerebral vasodilation produces a longer perturbation in cerebral blood flow velocity, increasing the risk of cerebral ischemia.

Dataset Information

Computer tomography guided lung biopsy using interactive breath-hold control: a randomized study.

Publications

Computer tomography guided lung biopsy using interactive breath-hold control: a randomized study.

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