Long-term Follow-up of Imaging Findings Related to Hydrogel Tract Sealant Use in Percutaneous CT-guided Lung Biopsy

Monday, March 31, 2025

3:45 PM – 3:54 PM CT

Location: Music City Center, 207 CD

Presenting Author(s)

MS

Mohamed M. Soliman, MD

Resident
New York-Presbyterian Hospital/Weill Cornell Medicine, United States

Author/Co-author(s)

BG

Blake Gershon, MD

Resident
Weill Cornell Medical College, United States
JE

Joanna Escalon, MD

Assistant Professor of Clinical Radiology
New York-Presbyterian Hospital/Weill Cornell Medicine, United States
LG

Lauren K. Groner, DO, MS

Assistant Professor of Clinical Radiology
New York-Presbyterian Hospital/Weill Cornell Medicine, United States
BS

Brian W. Sullivan, RA

Radiology Assistant
New York-Presbyterian Hospital/Weill Cornell Medicine, United States
MC

Megan Cahill, MPH

Research Associate
New York-Presbyterian Hospital/Weill Cornell Medicine, United States
DS

Deirdre Sullivan, RA

Radiology Assistant
New York-Presbyterian Hospital/Weill Cornell Medicine, United States
GA

Gulce Askin, MPH

Statistician
Weill Cornell Medicine, United States
Bradley B. Pua, MD, FSIR

Associate Professor of Radiology
New York Presbyterian - Weill Cornell Medical College, United States

Purpose: This study examines the imaging findings and malignancy suspicion associated with hydrogel lung tract sealants (h-LTS) used after CT-guided lung biopsy (CTLB).

Materials and Methods: Charts of patients who underwent CTLB from 01/2016 to 01/2020 were reviewed for biopsy date, h-LTS use, resection, and imaging follow-up. Exclusion criteria included resection < 3 months post-biopsy, no imaging ≥3 months, and pleural nodules. Post-biopsy imaging was analyzed for abnormalities at the biopsy site. Out of 164 patients who underwent CTLB with h-LTS, a random subset of 64 patients (Group A) was anonymized and compared with another randomly selected, anonymized group of 64 patients who underwent CTLB without h-LTS during the study period (Group B) to assess inter-reader agreement. Two cardiothoracic radiologists, blinded to h-LTS use and final pathology results, reviewed the anonymized intra-procedural biopsy CT and follow-up imaging at multiple intervals (3-6, 6-12, 12-24, >24 months) for abnormalities along the biopsy tract and associated malignancy suspicion (Categories 1-5 [10%, 25%, 50%, 75% >90%]). Descriptive statistics and weighted kappa coefficient were calculated.

Results: A serpiginous lesion was observed along the biopsy tract in 60% (99/164) of patients who received h-LTS, lasting an average of 23.3 months (95% CI: 19.7-26.9, range 3-67). Moderate inter-reader agreement was seen for abnormalities in Group A patients at all follow-up intervals (initial follow-up: k=0.66, second: k=0.72, third: k=0.70). FDG-PET/CT showed mild uptake for up to 5 years in 46% of patients. At initial follow-up, 17% of h-LTS scars were rated Category 3 or higher suspicion for malignancy. Most h-LTS scars maintained or decreased in suspicion (Category 2 or lower) in later follow-ups.

Conclusion: h-LTS is associated with a persistent serpiginous scar, which may be mildly hypermetabolic and last up to five years. Awareness of these findings is important to avoid unnecessary diagnostic and therapeutic procedures.