RPS 309 - Image-guided tissue biopsies and thyroid interventions

Author Block: P. Marra, L. Dulcetta, R. Muglia, F. S. Carbone, A. Weber, S. Ferrari, A. Rambaldi, P. A. Erba, S. Sironi; Bergamo/IT
Purpose: Surgical excision biopsy of lymph nodes stands as the gold standard for histological characterization of lymphoproliferative disorders (LD). However, contemporary clinical practice increasingly leans towards core needle biopsy (CNB). This study seeks to explore the factors influencing the diagnostic yield of CNB in LD.
Methods or Background: This unicentric retrospective study presents data from patients referred for suspicion of new or relapsing LD. All patients underwent image-guided CNB of the target lesion based on CT/PET findings. The primary endpoint was the diagnostic outcome, comparing the ability to achieve a definitive diagnosis according to international guidelines with CNB versus the necessity for subsequent excisional biopsy.
Results or Findings: We enrolled 478 consecutive patients undergoing CNB, categorized into two cohorts. Cohort A comprised patients who underwent CNB using 18-20G full-core Menghini needles, with a median macroscopic fragment dimension of 1 cm. Cohort B included patients who underwent CNB with 16-18G semiautomatic guillotine needles, with a median macroscopic fragment dimension of 1.5 cm. In cohort A, the rates of diagnostic and non-diagnostic (or non-sufficiently detailed) CNBs were 95 (73%) versus 35 (27%), respectively. In cohort B, these rates were 299 (86%) versus 49 (14%).
Conclusion: The type and size of the needle used for CNB, as well as the histologic variant of LD, emerged as factors influencing diagnostic yield and accuracy. Given the swiftness of CNB compared to surgical excision, optimizing this technique could streamline the diagnostic and therapeutic workflow for patients with suspected LD.
Limitations: Retrospective study; lack of control group undergoing surgery
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Comitato Etico di Bergamo - Lymphoid Cancer Registry (NCT03131531)

Author Block: N. Maalouf¹, M. Abou Mrad¹, R. Benayed¹, R. A. Pugliesi², J. C. Apitzsch¹; ¹Pforzheim/DE, ²Stuttgart/DE
Purpose: This study evaluates the relationship between the needle-pleura angle and the duration of needle traversal (NTD) through lung tissue during CT-guided lung biopsies, and their impact on the incidence of pneumothorax.
Methods or Background: 96 patients (54 m, 42 f, median age: 71 years) underwent CT-guided lung biopsies between January 2020 and March 2024. Procedures were performed using a semi-automatic 18G needle and a 17G trocar. The minimum delta (δmin) was calculated as the absolute difference between a 90° angle and the measured angles to the pleura and correlated with pneumothorax occurrence. NTD was recorded from needle puncture to retraction. Patients with immediate intraprocedural pneumothorax were excluded. A multivariate analysis compared four patient groups, categorized by δmin (greater or less than ten degrees) and NTD (less than or more than six minutes).
Results or Findings: 96 biopsies were performed, with six patients excluded. Pneumothorax occurred in 22 out of 90 procedures. Six of these 22 patients had δmin greater than 10 ° and NTD over six minutes; five had δmin less than ten degrees and NTD under six minutes. In contrast, 68 patients did not experience pneumothorax. Of these, 29 had δmin less than ten degrees with NTD under six minutes, while 20 had δmin less than ten degrees with NTD over six minutes. Pneumothorax occurred in 14.7% of patients with δmin less than ten degrees and NTD under six minutes, compared to 33.3% with δmin greater than ten degrees and NTD over six minutes.
Conclusion: Optimizing the needle-pleura angle and minimizing needle traversal duration during CT-guided lung biopsies can reduce pneumothorax risk.
Limitations: A relatively small number of patients, as it was a single-center observational study.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Approved by the local ethics committee (F-2021-038)

Author Block: C. Verde, V. Stoia, L. Tarotto, S. Stilo, R. D'Angelo, V. Sanna, N. Martucci, L. Arenare, F. Fiore; Naples/IT
Purpose: The purpose of this study was to evaluate sensitivity and specificity of FNAC with ROSE in the diagnosis of lung lesions.
Methods or Background: The study was conducted at the INT of Naples “Foundation Pascale” between 2013 and 2017.
CT, CBCT FNAC was performed on 643 patients, of which 195 subsequently underwent surgical resection.
Exclusion criteria were: platelet count (< 50,000) and INR (> 1.5).
Unenhanced TC scans or CBCT were performed pre-biopsy.
A 18 G coaxial needle is used and a thinner needle (23-22G) is inserted into the lesion (2-3 times, if necessary). FNAC is associated with the extemporaneous examination (ROSE), which evaluates the adequacy of the sample.
Pneumothorax is the most frequent complication but it is asintomatic in most cases and only 7 % of cases requests pleural drainage.
No evidence of other major complications.
Results or Findings: Comparing surgical cytological and histological samples, positive cytological samples are neoplastic in 99.3% of cases (152/153) and non-neoplastic in only 0.6% of cases (1/153). The sensitivity of FNAC is 86.8%, the positive predictive value 99.3% and the specificity 75%.
Conclusion: FNAC is a reference diagnostic tool in the characterization of lung lesions for the purpose of target therapy and immunotherapy.
It is an effective procedure with high sensitivity and specificity and low complication rate. Extemporaneous testing increases sensitivity, reducing the number of inadequate samples and false negatives.
Limitations: Single center study.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: No information provided by the submitter.

Author Block: M. Khaleghi¹, A. Aziz Ahari²; ¹Tehran/IR, ²Boston, MA/US
Purpose: The aim of this study is to investigate target thyroid nodules based on shear wave elastography.
Methods or Background: Suspicious nodules requiring fine-needle aspiration (FNA) can sometimes be heterogeneous. Even though they may appear homogeneous on ultrasound at times, they are heterogeneous on shear wave elastography examination. Sampling from highly suspicious areas in shear wave elastography evaluation can lead to decreased inadequate samples and increased detection of malignant thyroid diseases. In the present study, patients referred for thyroid nodule sampling undergo elastography assessment and are included in the study if they exhibit heterogeneity. They then undergo thyroid FNA under ultrasound guidance using a 22-gauge spinal needle with stylet.
Results or Findings: As of today, five patients have been examined. In these patients, inadequate or inappropriate samples were not observed. Suspicious areas in elastography in these patients had high indices above 80 kPa, while non-suspicious areas were below 40 kPa. All these patients were diagnosed with papillary thyroid cancer.
Conclusion: Thyroid nodules have always been a significant challenge. Shear wave elastography presents a new criterion for better diagnosis of suspicious nodules. Target thyroid FNA as a new concept should receive attention.
Limitations: One of the limitations of this study is the necessity of a highly skilled radiologist who can accurately sample high-risk areas.
Funding for this study: No Funding is received.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This research has been reviewed and approved by the National Ethics Committee under the number IR.IUMS.FMD.REC.1399.177

Author Block: P. Glielmo, G. Mauri, D. Albano, S. Gitto, S. Fusco, L. M. Sconfienza; Milan/IT
Purpose: Radiofrequency ablation (RFA) and microwave ablation (MWA) are minimally invasive techniques used to treat benign thyroid tumours. This study aims to compare the efficacy and safety of these two methods.
Methods or Background: We retrospectively evaluated all patients with benign thyroid nodules treated with either RFA or MWA at our Istitution between January 2021 and December 2021. The primary outcomes assessed were the volume reduction rate (VRR) of the ablated areas at 1, 6, 12 and 24 months, procedure duration, and complication rates.
Results or Findings: A total of 56 patients were enrolled, 35 treated with RFA and 21 with MWA. At 1 month, the VRR was 57% in the MWA group and 48% in the RFA group (p=0.045). At 6 months, both groups showed a VRR of 72%. At 12 months, the VRR was 75% in the MWA group and 76% in the RFA group and at two years of 76% in MWA group and 75% in RFA group. Both techniques achieved significant volume reduction with no major complications reported.
Conclusion: Both RFA and MWA are effective and safe for treating benign thyroid nodules. MWA demonstrated a higher initial VRR at 1 month, while both techniques achieved similar efficacy at 6, 12 and 24 months. These findings support the use of either method as viable non-surgical alternatives for patients seeking treatment options for benign thyroid nodules.
Limitations: Limitations of this study include its retrospective design, relatively small sample size, and absence of a control group for direct comparison.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: “This study was approved by the Ethical Committee of IRCCS Ospedale Galeazzi - Sant'Ambrogio, and all participants provided informed consent in accordance with the Declaration of Helsinki.”

Author Block: G. Mauri, P. Glielmo, D. Albano, S. Gitto, S. Fusco, L. M. Sconfienza; Milan/IT
Purpose: Thermal ablation has emerged as a minimally invasive treatment option for thyroid microcarcinomas, offering an alternative to surgery. This study presents a 7-year experience (2018-2024) in treating thyroid microcarcinomas with thermal ablation.
Methods or Background: We retrospectively evaluated all patients who underwent US-guided thermal ablation for thyroid microcarcinomas between January 2018 and September 2024. We assessed the technical efficacy of the procedure, complications, and local or distant recurrences.
Results or Findings: Of the 59 patients referred for evaluation, 5 were deemed unsuitable for thermal ablation, and 1 opted for surgery. The remaining 53 patients (40 females, 13 males; mean age 51.4 ± 7.7 years) underwent thermal ablation successfully. The procedure was well-tolerated with no major adverse events. The follow-up period ranged from 71 to 2 months (mean 36 months). No local or distant recurrences occurred.
Conclusion: Thermal ablation is a safe and effective treatment for thyroid microcarcinomas, providing a viable alternative to surgery. This 7-year experience supports its role as a standard treatment option for thyroid microcarcinomas, demonstrating excellent outcomes in terms of safety and efficacy in tumour control.
Limitations: Limitations of this study include its retrospective design, relatively small sample size, and absence of a control group for direct comparison.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Ethical Committee of IRCCS Ospedale Galeazzi - Sant'Ambrogio, and all participants provided informed consent in accordance with the Declaration of Helsinki.

Author Block: W-C. Lin, Y. J. Lee, C-K. Wang, A-N. Lin, Y-S. Chen, C. Y. Lee, P-L. Chiang, C. Y. Lu; Kaohsiung City/TW
Purpose: This study aims to compare the efficacy and safety of radiofrequency ablation (RFA) and transarterial embolization (TAE) in managing large benign thyroid nodules (BTNs), particularly those exceeding 100 mL, where established guidelines are limited.
Methods or Background: This retrospective multicenter study, conducted from January 2018 to May 2022, included 70 patients with a total of 76 large BTNs. Of these, 53 underwent RFA and 17 underwent TAE. Nodules were categorized by initial volume (<50 mL, 50–100 mL, >100 mL) and diameter (<6 cm, 6–9 cm, >9 cm). Treatment efficacy was evaluated using the volume reduction rate (VRR) at 6 months. Complications, as well as improvements in symptom and cosmetic scores, were documented and analyzed.
Results or Findings: At 6 months, TAE demonstrated a significantly higher mean VRR than RFA (p = 0.007), especially for nodules larger than 100 mL (TAE: 63.34% vs. RFA: 49.71%; p = 0.035). The complication rate in the TAE group (5.88%) was lower than that in the RFA group, where transient hoarseness and hematoma were common complications. Both treatments resulted in significant improvements in symptom and cosmetic scores (p < 0.001), with TAE providing greater improvements in larger nodules.
Conclusion: TAE is more effective and has fewer complications than RFA for the treatment of large BTNs exceeding 100 mL. These findings suggest that TAE may serve as a minimally invasive alternative to surgery for patients with large thyroid nodules. Further prospective studies are necessary to develop size-specific guidelines for selecting between RFA and TAE.
Limitations: Our study's limitations include the absence of gross pathological confirmation, retrospective design, short-term follow-up, and variations in TAE protocols.
Funding for this study: No funding was received for this article.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Chang Gung Medical Foundation Institutional Review Board
IRB No.: 202401138B0