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Abstract Background Definitive diagnosis of peripheral pulmonary lesions (PPLs) depends on the histological analysis of the pleural biopsy sample. Ultrasound (US)-guided sampling is now standard practice in the clinical setting. However, determining a suitable needle size and sampling times to improve the efficacy and safety of the biopsy remains challenging. Here, we compared the efficacy between 16- and 18-gauge core biopsy needles in US-guided percutaneous transthoracic biopsy for PPLs on histological diagnosis and procedure-related complications. Materials and methods In total, 1169 patients (767 men, 402 women; mean age, 59.4 ± 13.2 years) who received biopsy for PPLs between September 2011 and February 2019 were included. The propensity score matching (PSM) analysis was performed to adjust the baseline differences, and the rate of successful specimen assessment and complications were compared between the 16-gauge (249 patients) and 18-gauge (920 patients) groups. The number of pleural surfaces crossed (NOPSC) was defined as the number of times the visceral pleural surface was transgressed. Stratified analysis was performed based on NOPSC. Results The overall success rate was 92.0% (1076/1169). The overall complication rate was 9.6%, including pneumothorax, hemorrhage, and vasovagal reaction, which occurred in 2.5% (29/1169), 6.6% (77/1169), and 0.5% (6/1169) of the patients, respectively. When NOPSC was 1 or > 2, the success and complication rates in the 16-gauge group were comparable to those of the 18-gauge group (all P > 0.05). When the NOPSC was 2, the success rate in the 16-gauge group was significantly higher than that in the 18-gauge group (P = 0.017), whereas the complication rate was comparable (P > 0.05). Conclusion Higher success rate could be achieved using a 16-gauge than an 18-gauge core biopsy needle in the US-guided percutaneous transthoracic biopsy for PPLs when the NOPSC was 2. We recommend using 16-gauge needles with 2 times of needle passes in biopsy for PPLs in clinical practice.

Purpose To summarize the published literature on thermal ablation for primary hyperparathyroidism (PHPT) and to evaluate the effectiveness and safety of thermal ablation as a novel treatment strategy. Materials and methods Two authors carried out the literature search using four databases independently, including PubMed, Embase, Cochrane, and Web of Science. The meta-analysis included prospective and retrospective data that compared post-ablative outcomes to pre-ablative values. The primary outcomes were parathyroid hormone (PTH), serum calcium and volume of the parathyroid gland (VPG). Results From the 184 original articles, five studies (4 retrospective studies and 1 prospective study) examining 84 patients met the inclusion criteria. The meta-analysis showed significant reduction of PTH at 3 (standardized mean difference (SMD) = −1.09, 95% confidence index (CI) = −1.42 to −0.76, p

PurposeTo evaluate diagnostic performance and safety of ultrasound-guided needle biopsy in the diagnosis of peripheral pulmonary nodules (PPLs) ≤ 2 cm, and the influence factors of sample adequacy and safety.Materials and Methods194 patients (99 men, 95 women; mean age, 56.2 ± 13.7 years) who received biopsy for PPLs ≤ 2 cm between January 2014 to January 2019 were included. Variables including patient demographics, lesion location, lesion size, presence of lesion necrosis, presence of emphysema on CT, patient position, biopsy needle size and number of needle passes were recorded. Univariate analysis and multivariate logistic regression analysis were performed to explore the influence factor of sample adequacy and safety.ResultsBiopsy specimens were adequate for diagnosis in 161/194 (83%) cases; the diagnostic accuracy was 81.4% (158/194). The overall complication rate was 8.8% (17/194), including pneumothorax, hemoptysis and pleural effusion, which occurred in 2.1% (4/194), 5.2% (10/194), and 1.5% (3/194) of patients, respectively. The incidence of pneumothorax in the 16-gauge-needle group were significantly higher than that of the 18-gauge-needle group (5.6% vs 0%, P=0.018). Adequate sampling of 16-gauge and 18-gauge needles were achieved in 90.3%(65/72) and 78.7%(96/122) cases, respectively. Multivariate logistic regression analysis revealed needle size (16-gauge vs 18-gauge) was an independent influence factors of sample adequacy (P=0.015, odds ratio=3.419). A receiver operating characteristic curve was plotted and the area under the curve was 0.774.ConclusionUS-guided percutaneous needle biopsy is a feasible and safe technique for small PPLs ≤ 2 cm. Needle size is an independent influence factor of sample adequacy and post-procedure pneumothorax. Sixteen-gauge needle has the advantage of achieving adequate sample for pathological analysis, though the risk of pneumothorax should be alerted.

Aim: To investigate the application of ultrasound along with clinical features for the differential diagnosis of low-grade appendiceal mucinous neoplasm (LAMN) and acute suppurative appendicitis (ASA). Material and methods: The ultrasound and clinical data of 76 patients with histopathologically confirmed LAMN (31 patients) and ASA (45 patients) were retrospectively analyzed. Univariate analysis and binary logistic regression analysis of the influencing factors were conducted to identify LAMN and ASA. The AUROC was calculated to analyze the diagnostic efficacy of these independent factors. A four-grid table was established to determine the diagnostic efficacy of the ultrasound marks for diagnosing LAMN. Results: Patient age and appendix short diameter in the LAMN group were found to be significantly higher than those in the ASA group. The neutrophil ratio and thickness of the appendix wall in the LAMN group were significantly lower than they were in the ASA group. Patient age (OR=1.112, p=0.015) and appendix short diameter (OR=1.476, p=0.008) were independent risk factors for LAMN. The AUROCs for age and short diameter were 0.898 [95% CI: 0.807, 0.956] and 0.953 [95% CI: 0.879, 0.988], respectively. The LAMN group tumors were characterized by the appearance of an "onion skin" sign or a purely cystic mark on sonograms, with specificities of 100% for both. Neutrophil ratio (OR<0.001, p=0.064) and thickness of the appendix wall (OR=0.776, p=0.414) were not independent risk factors for ASA. Conclusion: Employing ultrasonography with clinical features is useful for distinguishing LAMN from ASA. Patient age, short diameter of the appendix, and sonographic appearance of "onion skin" or purely cystic mark could be key factors in diagnosing LAMN. [ABSTRACT FROM AUTHOR]