Tag Archives: thoracic biopsy

Johnny up and biopsy is a go

CT BIOPSY LUNG (LEFT) – Details

TECHNIQUE: Diagnostic CT BIOPSY LUNG (LEFT)

INDICATION: Metastatic lung cancer

Consent: The nature of the procedure, including its risks, benefits and alternatives was explained to the patient who understood and gave consent.

TECHNIQUE: 

The patient was placed prone on the CT table. Targeted preprocedure CT images demonstrated a dominant left lower lung mass, not significantly changed compared to chest CT from 5/23/2021. This was identified as the biopsy target.

After identifying a direct path to the target, the overlying skin was prepped and draped in the usual sterile fashion. A “time-out” was performed prior to initiation of the procedure to reconfirm the patient’s name, date of birth, and site of procedure. 15 cc of 1% lidocaine were administered for local anesthesia.

Using CT guidance, a 19-gauge introducer needle was percutaneously placed in the target using posterior approach. The stylet was exchanged for a 22-gauge Chiba needle and aspirates were obtained for slides. Additional fine needle aspirates were collected in a vial filled with normal saline. Subsequently, multiple tissue cores were obtained using a 20-gauge spring-loaded device. Tissue samples were handed to the cytopathology technologist and research assistant.

Post procedure images demonstrated no significant hemorrhage or pneumothorax.

ANESTHESIA: Intravenous conscious sedation was administered by radiology nursing. Continuous hemodynamic and respiratory monitoring was performed, including the use of pulse oximetry.

START TIME: 8:15 AM

STOP TIME: 9:03 AM 

Medications: As per medication administration record

CONDITION/COMPLICATIONS: The patient was brought to the radiology recovery room. Post procedure chest radiographs were obtained one hour and three hours after the procedure.

DISPOSITION: Oral and written post-procedure instructions were given.

IMPRESSION: 

Needle aspiration and core biopsy of left lung mass without immediate complications.

And here we go

I had a scan on Sunday and the report was just posted. From a personal perspective, I would have to say it is not good news. Rather aggressive growth over a two month period.

So damn.

I am not surprised. My body and I have a rather tacit understanding. And what I have been hearing has been progression.

On Thursday I shall meet with both Jessica Lin and Alice Shaw. We shall go over the scans but also discuss the possibility of a biopsy–something I am requesting. The hackathon has been going strong and several offers have come in for further genetic testing and maybe even an attempt at creating a mouse model–if tissue is available.

As my tumor burden has increased somewhat significantly, I would say the answer is probably yes. However there is still the question of location, location–is it accessible.

Thursday can’t come fast enough as I shall feel more comfortable with some answers as to what direction we will be heading. The one thing I can say with assurance is onward. This party’s not over.

CT Chest – Details

TECHNIQUE: Diagnostic CT CHEST WITH CONTRAST

COMPARISON: Prior exams, most recently a chest CT from 3/5/2021.

FINDINGS:

Lines/tubes: None.

Lungs and Airways: There is biapical pleural scarring with increase in the adjacent pleural fluid at the left lung apex. Again demonstrated are postoperative changes status post left lower lobectomy. Within the inferior aspect of the left upper lobe there is parenchymal consolidation which has increased from prior. Inferiorly and anteriorly, consolidation measures approximately 8.2 x 5.1 cm on image 364 series 4, increased from 4.2 x 5.1 cm as measured in the same fashion on chest CT from 3/5/2021. This consolidation extends anteriorly and inferiorly with increase in the subpleural nodularity which now measures 41 mm in length as on image 303 of series 4, previously approximately 37 mm with increase in the adjacent consolidation and groundglass opacity. There is increasing consolidation which extends inferiorly as well, now measuring approximately 5.9 x 4.9 cm in image 4 4 of series 4, increased from 2.9 x 2.0 cm as measured at the same level on prior exam. There is intralobular septal thickening as in image 360 of series 4 which lymphangitic spread of tumor cannot be excluded. There is increase in the adjacent loculated left pleural fluid. A right upper lobe pulmonary nodule measures 6 mm on image 251 of series 4, not significantly changed when compared back to at least 1/5/2021. There is adjacent reticular opacity consistent with scarring. Mild nodularity along the right minor fissure measuring up to 5 mm on image 268 of series 4 is stable when compared to 1/5/2021 and likely represents a fissural lymph node. Other small nodules along the right major fissure are stable. There is a 3 mm nodule in the right upper lobe on image 148 of series 4, stable back to 1/5/2021. No new or enlarging right-sided nodules are seen. There is reticular opacity in the right lower lobe with associated subpleural bands, stable from prior and likely due to atelectasis/scarring. The central airways remain patent.

Pleura: There is a small left pleural effusion with loculation which has increased at the left lung apex. Left basilar loculated pleural fluid has also mildly increased when compared to 3/5/2021. There is no right pleural effusion. There is no pneumothorax.

IMPRESSION: 

1. Status post left lower lobectomy with continued increase in consolidation within the inferior left upper lobe when compared to 3/5/2021 highly suspicious for progression of known malignancy. There is adjacent interlobular septal thickening for which lymphangitic spread of tumor cannot be excluded.

2. Mild increase in volume of loculated left pleural fluid superiorly and inferiorly when compared to 3/5/2021.

3. No significant change in scattered right pulmonary nodules measuring up to 6 mm. No new or enlarging right-sided nodules are seen.