This study investigated strategies to reduce pneumothorax risk in CT-guided lung biopsy. The approach involved administering 10 ml of 1 % lidocaine fluid in the subpleural or pleural space before lung puncture and utilizing the gravitational effect of pleural pressure with specific patient positioning. We retrospectively analyzed 72 percutaneous CT-guided lung biopsies performed at a single center between January 2020 and April 2023. These were grouped based on fluid administration during the biopsy and whether the biopsies were conducted in dependent or non-dependent lung regions. Confounding factors like patient demographics, lesion characteristics, and procedural details were assessed. Patient characteristics and the occurrence of pneumothoraces were compared using a Kurskal-Wallis test for continuous variables and a Fisher's exact test for categorical variables. Multivariable logistic regression was used to identify potential confounders. Subpleural or pleural fluid administration and performing biopsies in dependent lung areas were significantly linked to lower peri-interventional pneumothorax incidence (n = 15; 65 % without fluid in non-dependent areas, n = 5; 42 % without fluid in dependent areas, n = 5; 36 % with fluid in non-dependent areas,n = 0; 0 % with fluid in dependent areas; p = .001). Even after adjusting for various factors, biopsy in dependent areas and fluid administration remained independently associated with reduced pneumothorax risk (OR 0.071, p<=.01 for lesions with fluid administration; OR 0.077, p = .016 for lesions in dependent areas). Pre-puncture fluid administration to the pleura and consideration of gravitational effects during patient positioning can effectively decrease pneumothorax occurrences in CT-guided lung biopsy.

Background/Objectives: This study aimed to investigate pneumothorax risk, focusing on the gravitational effect of pleural pressure caused by specific patient positioning. Methods: We retrospectively analyzed 144 percutaneous CT-guided lung biopsies performed between January 2019 and December 2023. Patients were grouped into those with or without pneumothorax. Variations in patient positioning (prone, supine, lateral, lesion in decubitus biopsy-side-down [LD BSD] and the dependent area [L DA M], and access route beginning in the dependent area [AR LD M]) were compared using the chi-square, Fisher’s exact, and Mann–Whitney U tests. Performance metrics were evaluated. Univariate and binomial logistic regression models assessed the influence of these factors and other patient-related and interventional parameters on pneumothorax occurrence. Results: Three positional variants (AR DA M, L DA M, and L LD BSD; p < 0.001), general emphysema (p = 0.009), emphysema in the access route (p = 0.025), greater needle size (18G vs. 20G; p < 0.001), and the use of a side-cut instead of a full-core system (p = 0.002) were significantly linked to lower peri-interventional pneumothorax incidence. Even after adjusting for various factors, AR DA M and general emphysema remained independently associated with a reduced pneumothorax risk (OR 0.168, p < 0.001; OR 2.72, p = 0.034). Assessing the dependent zones showed superior performance regardless of the patient’s position, with the best performance demonstrated for AR DA M (AUC 0.705; sensitivity 60%, specificity 81.8%). Conclusions: Focusing on the dependent zones of each lung and adjusting the access route accordingly can significantly reduce the risk of pneumothorax compared to conventional positioning techniques.

Objectives: The distinction of clinically uncertain, poorly differentiated liver masses into primary liver cancer (PLC) of cholangiocytic origin (intrahepatic cholangiocarcinoma; CCA) or hepatocellular origin (hepatocellular carcinoma; HCC) vs. metastasis is highly relevant to guiding patient treatment. Protocols differ in terms of resection, local ablation, liver transplantation, or systemic therapies with immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs). Methods: This retrospective case series exemplifies a multidisciplinary, practical guide to clinically uncertain liver masses using imaging, histomorphology, immune phenotyping, and mutational testing of telomerase promoter (TERT) combined with a literature review. Results: In 2/3 patients with uncertain liver masses and inconclusive immunohistochemistry profiles, TERT testing supported the diagnosis of poorly differentiated hepatocellular carcinoma. The third case with a history of sclerosing cholangitis and vague adenoid morphology yielded mutations in ARID1a and TP53 and was identified as primary liver cancer, consistent with poorly differentiated intrahepatic cholangiocarcinoma or mixed hepatocellular cholangiocarcinoma (cHCC/CCA). Conclusions: Finding HCC-typical TERT promoter mutations is a useful diagnostic tool in poorly differentiated primary liver cancer.

Some radiological contrast agents have been shown to have effects on bacterial growth. In this study, the antibacterial effect and mechanism of action of iodinated X-ray contrast agents (Ultravist 370, Iopamiro 300, Telebrix Gastro 300 and Visipaque) and complexed lanthanide MRI contrast solutions (MultiHance and Dotarem) were tested against six different microorganisms. Bacteria with high and low concentrations were exposed to media containing different contrast media for various lengths of time and at pH 7.0 and 5.5. The antibacterial effect of the media was examined in further tests using agar disk diffusion analysis and the microdilution inhibition method. Bactericidal effects were found for microorganisms at low concentrations and low pH. Reductions were confirmed for Staphylococcus aureus and Escherichia coli.

Purpose: The study aimed to evaluate whether the relative height (RH) of the entry point (EP) during CT-guided lung biopsies, adjusted for patient positioning, can predict the risk of pneumothorax during the intervention, leveraging the gravitational effects on pleural pressure. Materials and methods: We retrospectively analyzed 128 percutaneous CT-guided lung biopsies performed at a single center between January 2018 and December 2023. Patients were grouped based on pneumothorax occurrence. Various measurement methods indirectly assessed the influence of gravitational force on pleural pressure, focusing on the RH at the EP with prone positioning adjustments (PP). Other confounding factors like patient demographics, lesion characteristics, pre-puncture fluid administration and other procedural details were assessed. Test performance metrics were compared using Chi-Square, Fisher’s exact, and Mann–Whitney U tests. Univariate and binomial logistic regression assessed the influence of different parameters on pneumothorax occurrence. Results: All measurements of lower RH at EP and pre-puncture fluid administration were significantly associated with a reduced incidence of peri-interventional pneumothorax (p < 0.01). The RH at EP adjusted for the prone position demonstrated the best predictive performance (AUC = 0.844). After adjusting for various confounding factors, both lower RH at EP adjusted for the prone position (OR 110.114, p < 0.001) and pleural fluid administration (OR 0.011, p = 0.011) remained independently associated with a lower risk of pneumothorax. Conclusion: Strategic use of gravity by selecting the lowest possible entry point, ideally positioning the patient laterally, combined with pre-puncture pleural fluid administration, could be the key to reducing pneumothorax in CT-guided lung biopsies.

Percutaneous needle biopsy of the lung (PCBL) under image guidance has become a safe and effective minimal invasive method to obtain a specimen related histological diagnosis of pulmonary lesions. To evaluate the diagnostic yield and safety of two different coaxial biopsy technologies: full core and notch sampling technology. The former allowing the removal of full punch cylinders and the latter using a cutting-edge mechanism. A retrospective analysis of 48 consecutive PCBL procedures has been carried out for this prognostic study, involving patients with a documented pulmonary nodule or mass lesion on previous computed tomography (CT) scans. The study population included 38 men and 10 women (mean age = 67 years). Of these 48 patients who underwent a procedure with a co-axial cutting system, 24 have been performed with notch sampling technology and 24 with full core technology. Out of the 48 biopsy procedures, 46 yielded specimens were adequate for histopathological evaluation, consistent with a technical success rate of 96%. The most common induced image-guided biopsy complication was a pneumothorax, occurring in 14 patients (35%). Seven patients with a pneumothorax were attributed to the full core technology and seven to the notch sampling technology (odds ratio = 1, 95% confidence interval = 0.28–3.51, P = 1). In the setting of full core versus notch sampling percutaneous CT-guided coaxial needle biopsy of the lung, no significant difference in the diagnostic accuracy and the incidence of pneumothoraces could be shown, while both technologies have an excellent diagnostic performance.