SIR 2024
Imaging
Ahmad Ara'R, MD (he/him/his)
Visiting Researcher
University of Texas Southwestern Medical Center
Disclosure information not submitted.
Mhd Wisam Alnablsi, MD
research associate
UTSW Medical Center/Dept of Radiology
Disclosure information not submitted.
Samuel Rice, MD
Assistant Professor
University of Texas, Southwestern
Disclosure information not submitted.
Anil K. Pillai, MD
Section Chief
University of Texas Southwestern
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Jamaal Benjamin, MD, PhD
Assistant Professor
University of Texas Southwestern Medical Center
Disclosure information not submitted.
Rehan Quadri, MD
Assistant Professor
UT Southwestern Medical Center
Disclosure information not submitted.
Percutaneous lung biopsy (PLB) has become the primary means of characterizing suspicious nodules or masses within the lung {1-2}. Real time touch prep (RTTP) cytological evaluation of biopsy samples is used at many institutions for an immediate assessment of tissue adequacy for diagnosis {3-4}. The purpose of this study was to compare RTTP to final histological diagnosis (HD) and the impact of RTTP on procedural time and outcomes.
Materials and Methods:
Single-center retrospective analysis of 555 consecutive patients who underwent PLB with RTTP between 12/16/2014 and 06/11/2019. Additionally, when a benign HD was obtained, follow-up imaging or repeat biopsy was done.
Results:
541 had both a conclusive final HD and RTTP. In 340 of these cases (62.8%), RTTP predicted a malignancy that was confirmed by HD. In 94 (17.4%), RTTP predicted a mass to be malignant that was later proven by HD to be benign. RTTP was negative in 107 cases; 40 of them were later proven to be positive for malignancy (7.4%) while the last 67 were confirmed negative by HD (12.4%) (Table 1).
Smaller lesions were significantly more likely to be diagnosed benign by both RTTP and HD (Table 2). However, the impact of size was significantly greater with RTTP than with HD.
The inadequacy of RTTP was significantly increased from 31.9% to 68.1% with pulmonary hemorrhage (p-value 0.001). While the rate of obtaining a final HD of malignancy is not affected by any complications. The number of slides when RTTP was inadequate was significantly higher than for those in which RTTP was adequate (4 vs 3, p-value < 0.001). The procedure time was significantly prolonged in procedures in which RTTP was inadequate (52 vs 43 minutes, p-value < 0.001).
Conclusion:
Real-time touch preparation is an intra-operative test that has a high sensitivity and low specificity for malignancy.
The tendency for radiologists to seek additional samples in negative RTTP must be cautioned against as a positive result is not reliable and in seeking one, the procedure may be prolonged, exposing the patient to a higher risk of complications.