1. 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

2. 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 The protocol have been promulgated by Ministry of Health

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

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

5. TRU-CUT NEEDLE BIOPSY 18-20G

6. CT SCAN MACHINE

7. LOCATED SUPPORT EQUIPMENTS
Lá kim tiêm

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

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

10. 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%.

11. PUNCTURE THE GUIDED SHEATH OF BIOPSY NEEDLE

12. 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

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

14. BIOPSY SAMPLE

15. FOLLOW UP
Pneumothorax;
Hemoptysis

16. RESULTS

17. 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 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;

18. 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%

19. CT SCAN FEATURES Features n= 85 % Lesion diameter ≤ 20 mm 16 18.821
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%

20. 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

21. 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.

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

23. 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%

24. 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%