EVALUATING THE EARLY EFFECTS OF TRU-CUT BIOPSY UNDER CT GUIDANCE IN PATIENTS WITH LUNG TUMOUR AT NATIONAL LUNG HOSPITAL. Dr. Phuong Ngoc Anh National Lung Hospital

INTRODUCTION The lesions lung tumor. Lung cancer is the most common malignancy in the word. High mortality, often late diagnosis. Diagnosis is pathology

INTRODUCTION Tru-cut biopsy under CT guidance In the word. In Viet Nam. Objectives: To evaluate the early effects of tru-cut biopsy under CT guidence in patients with lung tumours. To evaluate the safety of tru-cut biopsy under CT guidance in these patients.

TARGET POPULATION AND METHOD 1. Target Population: 56 patients with lung tumour was performed lung biopsy under CT guidance at National Lung Hospital, from November 2016 to February 2017 2. Method. 2.1. Method study: A prospective study.

TARGET POPULATION AND METHOD 2.2. Patient selection criteria Have lesions lung tumor. Patient had bronchoscopy but pathology not proportional image analysation. Not contraindication with tru-cut biopsy under CT guidance. Patinent agree with tru-cut biopsy under CT guidance.

TARGET POPULATION AND METHOD 2.3.Patient eliminate criteria. Contraindications: Blood clotting disorder symptoms or using antifreeze drugs. Doubt blood vessels tumor. Have balloon lung in the area biopsy needle. Not have the opposite lung. Severe heart failure, severe respiratory failure, patinent breathe by breathing machine. Patient with COPD (FEV1 < 1L) Patinent not agree with tru-cut biopsy under CT guidance.

TARGET POPULATION AND METHOD 3. Information collected: according to the unified medical model Age, gender, adress. History of the disease, risk factors. Clinical symptoms. Subclinical symptoms. Biopsy techniques: Posture, distance, tumor size, disaster and management. Cytology, pathology with brochoscopy and biopsy needle under CT guidance. 4. Methods of data processing and analysis : with SPSS16.0.

Pathology ( after 2 times) RESULTS AND DISCUSS Pathology ( the first) Total Malignant Lung disease Doubt malignant N 44 7 5 56 % 78.57% 12.5% 8.93% 100 Pathology with tru-cut biopsy under CT guidance with the first. Pathology with tru-cut biopsy under CT guidance after 2 times. The effect of diagnosis with the first is 91.07%. The effect of diagnosis is 96.43%. Pathology ( after 2 times) Total Malignant Lung díease Doubt malignant N 44 + 3 = 47 7 2 56 % 83.9 12.5 3.57 100

RESULTS AND DISCUSS General characteristics related to cancer Cancer Group (n=47 ) Non-cancer Group (n=9) Total(n=56) P N % n 0.715 Age Down 40 1 2.1 11.1 2 3.6 40-50 7 14.9 8 14.3 50-60 17 36.2 3 33.3 20 35.7 60-70 14 29.8 30.3 up 70 17.0 9 16.1 Total 47 100 56 Gender Male 36 76.6 88.9 44 78.6 0.65 Female 11 23.4 12 21.4 History smoking Smoking 27 57.4 5 55.6 32 57.1 0.925 Non smoking 42.6 4 44.4 24 42.9 General characteristics related to cancer The average age is 60.1 years, in which the youngest is 34 years old and the highest age is 80 years old. The same study by Nguyen Dinh Huong and CS (2011): mean age was 63.7 ± 11.4. The age difference between the cancer and non-cancer groups was not statistically significant at p = 0.715 The gender difference between the non cancerous and non-cancerous groups was statistically significant at p = 0.65 The difference in smoking history between the cancer and non-cancer groups was not statistically significant at p = 0.925.

RESULTS AND DISCUSS Characteristics tumor related to cancer Cancer Group(n=47) Non-cancer Group(n=9) Total(n=56) P N % n 0.038 Tumor size ≤ 30 mm 12 25.5 7 77.8 19 33.9 30-50 mm 21 44.7 1 11.1 22 39.3 50-70 mm 8 17.0 9 16.1 up 70 mm 6 12.7 10.7 Total 47 100 56 Tumor Location right upper lobes 13 27.7 2 22.2 15 26.8 0.568 right middle lobes 4 8.5 5 8.9 Right lower lobe 10 17.9 left upper lobe 3 33.3 16 28.5 Lower left lobe 19.1 Characteristics tumor related to cancer The average tumor size is 40.7 ± 21.7 mm, the smallest is 7mm and the largest is 120 mm, similar to that of Nguyen Van Dung and CS (2009). The average tumor is 41-45 mm, the smallest size is 8- 10mm. Tumors larger than tendency to malignancy rates are higher in tumors of ≤ 30 mm with the lowest incidence of cancer: 77.8%, the highest in the tumor group ≥70 mm with a cancer incidence of 100 %, the difference between groups was statistically significant with p = 0.038. The most common tumors in this group were the upper lobes (59.1%), the middle ones (8.9%) and the middle lobes (8.9%). The same study was conducted by Nguyen Dinh Huong and CS (2011). , the lowest middle lobe is 7.5%. The incidence of tumors in these sites was different but not statistically significant at p = 0.568.

RESULTS AND DISCUSS Attitudes and behavior Behavior n % Attitudes Hydropneumothorax oxygen therapy 4 30.8 Needle aspiration Chest tube placement 6 46.1 Hemothorax Hemoptysis Hemoptysis emergence 3 23.1 Total 13 100 13 patients (23.2%) have attitudes in this study. Hydropneumothorax is the highest (17.9%), Similar to Doan Thi Phuong Loan and CS (2013), the overall incidence was 21.9%, with hydropneumothorax accounting for the highest rate of 14.8%.

Distance of biopsy needle (mm) RESULTS AND DISCUSS Characteristics Accidents Total P Non-accident N % n Distance of biopsy needle (mm) ≤ 30 7 16.4 12.5 0.292 31 - 50 8 61.5 21 48.8 29 51.8 Up 50 5 38.5 15 34.8 20 35.7 13 100 43 56 Age ≤40 1 7.7 2.3 2 3.6 0.564 41-50 16.3 14.3 51-60 3 23.1 17 39.6 61-70 38.4 12 27.9 30.3 Up 70 6 13.9 9 16.1 Assessment of risk factors for accidents : Based on the distance of the biopsy, the incidence rate in the 31-50 mm group was highest at 27.6%, the lowest at 30 mm, but not statistically significant at p = 0.292 We found that the incidence of dementia increased with increasing age, with the highest incidence of over 70 years of age 33.3% but no statistically significant at p = 0.564.

RESULTS AND DISCUSS Assessment of risk factors for accidents: Characteristics Accidents Total P Non accidents N % n Tumor size (mm) ≤30 6 46.2 13 30.2 19 33.9 0.32 31-50 16 37.2 22 39.3 51-70 1 7.6 8 18.6 9 16.1 Up 70 13.9 10.7 100 43 56 Tumor location right upper lobes 5 38.4 10 23.3 15 26.7 0.88 right middle lobes 7.7 4 9.3 8.9 right lower lobes 2 15.4 17.9 left upper lobe 3 23.1 28.6 left lower lobe Assessment of risk factors for accidents: The size of tumors in the tumor size group was reduced when the tumor size increased with the tumor group ≤30mm (24%), the rate decreased as the tumor increased in size, with the tumor group over 70mm the rate was 0 %, but not statistically significant p = 0.32. Doi Thi Phuong Loan and CS (2013) did not show statistically significant reduction in worsening tumor size but not statistically significant for p = 0.62. According to the location of the tumor, the location with the highest incidence of stroke was the right upper lobe with a morbidity rate of 33.3%. Different sites had different incidence rates, but not statistically significant at p = 0.88. This result is similar to that of Nguyen Van Dung and CS (2009).

RESULTS AND DISCUSS Characteristics Cytology Total malignant cells Non-malignant cells N % n Pathology at 1 st Cancer 33 100 11 47.8 44 78.6 Non-cancer 12 52.2 21.4 23 56 Pathology at 2 st 2 1 33.3 3 60 66.7 40 5 To evaluate the early effects of tru-cut biopsy under CT guidence In 56 patients with biopsy, 47 patients diagnosed with cancer accounted for the highest rate of 83.93%, of which 35 cases had cytoplasmic response to malignant cells. Diagnosis results were 91.07% and 96.43%, respectively.

CONCLUSIONS The mean of age is 60.1 ± 10 years, male/female: 44/12 The minimum and maximum diamter of tumour is 7mm and 120 mm, respectively. The more tumour size increases, the more the rate of carcinoma increases with significant statistic. The most common location is the bilateral upper lobe lung ( 59.1%). The rate of complication is 23.2 %. There are no significant association between complications and factors such as the depth of needle, the tumour size, the tumour location and age groups.

CONCLUSIONS The effect of getting sample is 100 %, all of 56 patients have lung sample to diagnosis specimen and tissue pathology. 83.93% of patients( 47/56) was diagnosed lung cancer The effect of diagnosis is 96.43%.

CONCLUSIONS Tru-cut biopsy under CT guidance have high effects in getting lung sample and diagnosis. The rate of complication is low, and the complication is often mild. So as, tru-cut biopsy under CT guidance should be done to diagnosis lung tumour, but it should only be applied in specialized facility

THANK YOU