RESEARCH ON DIAGNOSIS OF LUNG CANCER WITH PERCUTANEOUS TRANSTHORACIC NEEDLE BIOPSY UNDER CT SCAN GUIDANCE Primary Investigator: Nguyễn Thanh Hồi, MD, PhD Investigators: Hai Phong International hospital; Viet Tiep Frienship hospital; Kien An General hospital

BACKGROUND Lung tumor: node, shadow on chest X ray, CT Scan; Causes of lung tumor: more than 80 types, can be classified as: malignant and benign tumors; Percutaneous transthoracic needle biopsy (PTNB): have been done from century 19th; In Vietnam: PTNB have been done from 1990. The protocol have been promulgated by Ministry of Health

AIMS OF RESEARCH Research on diagnosis of lung cancer with percutaneous transthoracic needle biopy under CT Scan guidance

PATIENTS Patients who had lung tumors; Non diagnostic histopathology by bronchoscopy, lymph node biopsy; negative AFB.

TRU-CUT NEEDLE BIOPSY 18-20G

CT SCAN MACHINE

LOCATED SUPPORT EQUIPMENTS Lá kim tiêm

BIOPSY PROTOCOL To take Scanogram film, determining the biopsy area. Moving the CT Scan table to the biopsy area.

BIOPSY PROTOCOL Turn on the red light, put injection needle plate on the biopsy area; Perform CT Scan on biopsy area

BIOPSY PROTOCOL Determining the biopsy slide. Measure the depth and the angle that the biopsy needle would approach to the lesion from the skin surface. Sâu: 5.2cm; Góc chọc: 90 độ Đánh dấu điểm chọc kim trên da. Trải khăn vô trùng. Đặt ốc định vị trên kim dẫn đường. Gây tê: xylocain 2%.

PUNCTURE THE GUIDED SHEATH OF BIOPSY NEEDLE

BIOPSY PROTOCOL Perform CT Scan again to access whether the biopsy needle approach to the lesion. Biopsy when the tip of biopsy needle in the lung tumor

BIOPSY PROTOCOL Biopsy 3-5 samples; Suction for cytology; Withdraw the guided sheath; Perform CT Scan again to check the incidents: pneumothorax, parenchymal bleeding

BIOPSY SAMPLE

FOLLOW UP Pneumothorax; Hemoptysis

RESULTS

AGE AND GENDER Features n % Age 21-40 10 11.8 41-60 36 42.4 61-80 32 37.6 ≥ 80 7 8.2 Total 85 100 Gender Male 49 57.6 Female Gặp bệnh nhân ở tất cả các lứa tuổi, tuy nhiên, các bệnh nhân có tuổi từ 41-70 chiếm tỷ lệ cao hơn. Tuổi trung bình của các bệnh nhân là 47,7. Kết quả này cũng tương tự của Đoàn Quốc Hưng nhận thấy tuổi trung bình của các bệnh nhân trong nghiên cứu là 44,8 Tuổi trung bình: 60 ± 15; Nguyễn Đình Hướng: 63,7 ± 11,4; Ngô Quý Châu: 57,1 ± 11,4. 97,8% BN Ung thư > 40 tuổi;

SIGNS AND SYMTOMS (n=85) SIGNS AND SYMTOMS n % Chest pain 38 44.7 Cough 42 49.4 Hemoptysis 5 5.9 Dysphagia 2 2.4 Extremity pain 8 9.4 Fatigue 13 15.3 Tired Dyspnea 24 28.2 Ngô Quý Châu et al (2006) research on 265 patients got lung biopsy under CT Scan guidance: chest pain: 59.2% (157/265), productive cough: 54%, dyspnea: 30.9%, fever: 29.4%, weight lost: 17%, hemoptysis: 13.4%

CT SCAN FEATURES Features n= 85 % Lesion diameter ≤ 20 mm 16 18.8 21 24.7 31-50 mm 27 31.8 51-70 mm 13 15.3 ≥ 70 8 9.4 Total 85 100% Lesion shape Round 10 11.8 Not round 75 88.2 Border of lesion Smooth 18 21.2 Not smooth 48 56.5 Spiculation 14 16.5 Thick wall cavity 5 58.8 Tổn thương có ở TT trước: 68,2%; TT giữa: 56,1%; TT sau: 12,1%

HISTOPATHOLOGY Histopathology n = 85 % Cancer 45 52,9 Tuberculosis 17 Enough sample for histopathologic diagnosis: 97,6%; Enough sample for cytologic diagnosis: 100% Histopathology  n = 85 % Cancer 45 52,9 Tuberculosis 17 20,0 Angio-fibrotic tumor 1 1,2 Thymoma 2 2,4 Fibrotic tumor Thyroid tumor Neurinome Chronic inflamation 16 18,8

INCIDENTS Incident N = 85 % Non incident 66 77.6 Incident 19 22.4 Tỷ lệ tai biến chung: 22,3%. 1 trường hợp phải mở MP dẫn lưu khí. Geraghty và CS (2003) NC trên 846 BN được STXTN dưới hướng dẫn của CLVT: tỷ lệ tai biến chung là 252 (30%) bao gồm TKMP là 226/846 (27%), 17 trường hợp ho máu; Đoàn Thị Phương Lan (2015): Tai biến khi sinh thiết lần 1 là 25%. Trong đó: 6 trường hợp phải mở MP dẫn lưu khí, 1 trường hợp mở màng phổi dẫn lưu tràn khí, tràn máu MP. Không ghi nhận chảy máu nhu mô là tai biến.

INCIDENT TYPES Incident N = 85 % Non Incident 66 77.6 Pneumothorax 10 11.8 Parenchyma bleeding 4 4.7 Hemoptysis 5 5.9

CONCLUSION Features of patients who had lung tumor Age: 60 ± 15. Male: 57.6%; Female: 42.4%. Signs and symtoms: cough (49.4%), Fatigue (44.7%), chest pain (44.7%) and dyspnea (28.2%), hemoptysis: 5.9% Smallest tumor: 6x7mm, average diameter: 29x38mm. Round tumor: 11.8%; Not smooth border: 78.8%

CONCLUSION 2. Causative diagnosis lung tumor with PTNB under CT Scan guidance Enough sample for histopathologic diagnosis: 100%, and enough sample for cytologic diagnosis: 97.6%; Histopathology: lung cancer: 45 (52.9%) patients; tuberculosis: 17 (20.0%) patients; angio – fibrotic tumor: 1 (1.2%) patient; thymoma: 2 (2.3%) patients; fibrotic tumor: 1 (1.2%) patient, thyroid tumor: 1 (1.2%) patient, neurinome: 2 (2.3%) patients, chronic inflamation: 16 (18.8%) patients. Incident: 22.4%