Schmanke Ken E, Zackula Rosalee E, Unruh Zachary A, Burdiek Wesley A, Trent Jesse J, Ali Kamran M
University of Kansas School of Medicine-Wichita, Wichita, KS.
Ofice of Research.
Kans J Med. 2020 Sep 11;13:235-241. eCollection 2020.
Efficient execution of image-guided percutaneous biopsy is a procedural competency milestone in radiology training. Despite the importance of achieving such mastery, literature on successful execution by residents is limited. The purpose of this study was to evaluate resident performance as measured by nondiagnostic biopsy and major complication percentages, on CT-guided transthoracic core needle biopsies (TTNB) of lung and mediastinal lesions.
A 12-year retrospective cohort study was conducted using charts from an academic hospital, 2006 - 2018, to evaluate TTNBs. Inclusion criteria were ≥ 18 years of age and ≥ 1 follow-up CT scan and chest x-ray. Bivariable associations by outcome(s) were evaluated.
Of 1,191 biopsies conducted, case distribution was 41%, 26%, 18%, and 15% for postgraduate years (PGY) 2 - 5, respectively. Results from biopsies were 139 (11.7%) nondiagnostic, 218 (18.3%) benign, and 834 (70.0%) malignant cases. Resident year by nondiagnostic outcome was not significant; p = 0.430. There were 148 major complications. Complication rate by PGY 2 - 5 was 13.0%, 13.3%, 12.9%, and 9.2%, respectively; differences were not significant, p = 0.488. Of the 139 nondiagnostic cases, 42 were re-biopsied during the study period with 81% re-classified as malignant; no repeat biopsy was observed for the remaining 97 nondiagnostic cases.
Of 1,191 lung/mediastinal biopsies analyzed, nearly 12% were nondiagnostic and over 12% had major complications; neither associated with resident level of experience. Outcomes were not affected significantly by level of training. Residency programs may benefit from affording opportunities for newer PGY classes to participate in procedures. Nondiagnostic cases may benefit from timely, repeat biopsies.
高效执行图像引导下经皮活检是放射学培训中的一项程序性能力里程碑。尽管掌握此项技术非常重要，但关于住院医师成功执行该操作的文献却很有限。本研究的目的是评估住院医师在对肺部和纵隔病变进行CT引导下经胸芯针活检（TTNB）时，以非诊断性活检和主要并发症发生率衡量的操作表现。
利用一家学术医院2006年至2018年的病历进行了一项为期12年的回顾性队列研究，以评估TTNB。纳入标准为年龄≥18岁且有≥1次随访CT扫描和胸部X光检查。评估了按结果分类的双变量关联。
在进行的1191例活检中，研究生二年级至五年级（PGY 2 - 5）的病例分布分别为41%、26%、18%和15%。活检结果为139例（11.7%）非诊断性、218例（18.3%）良性和834例（70.0%）恶性病例。非诊断性结果与住院医师年份无关；p = 0.430。有148例主要并发症。PGY 2 - 5的并发症发生率分别为13.0%、13.3%、12.9%和9.2%；差异不显著，p = 0.488。在139例非诊断性病例中，42例在研究期间进行了再次活检，其中81%重新分类为恶性；其余97例非诊断性病例未观察到重复活检。
在分析的1191例肺/纵隔活检中，近12%为非诊断性，超过12%发生主要并发症；两者均与住院医师经验水平无关。培训水平对结果无显著影响。住院医师培训项目可能会从为新的PGY班级提供参与操作的机会中受益。非诊断性病例可能会从及时的重复活检中受益。
