Objective To investigate the learning curve of CT-guided percutaneous lung biopsy.Methods Using cumulative sum(CUSUM)analysis method,the clinical data from 110 patients,who underwent CT-guided percutaneous lung biopsy performed by the same physician at the First Affiliated Hospital of Zhengzhou University of China between May 2024 and October 2024,were retrospectively analyzed.The CUSUM learning curve was fitted,and R2 was used to assess the goodness of fit.The baseline and perioperative data were compared between different stages of the learning curve so as to determine the number of accomplished surgical cases that was required for a physician to reach the proficiency stage from the learning stage in performing CT-guided percutaneous lung biopsy.Results Successful CT-guided percutaneous lung biopsy was accomplished in all patients,with a mean operation time of(20.2+3.4)minutes(range of 15-29 minutes).With the accumulation of surgical cases,the operation time showed a gradual downward trend.The learning curve was best fitted with a cubic equation,the equation was as follows:CUSUM(110)=0.000 3x3-0.081 3x2+5.597 9x+0.774 3(where x representing the number of cases),with a goodness-of-fit coefficient R2=0.991.The fitted curve reached its peak at the performance of the 46th case,which was used as the cutoff point to divide the learning curve into two phases.Compared with the learning phase,in the proficiency phase the incidence of complications was significantly lower(pneumothorax:18.8％vs 37.0％,P=0.033)and the mean operation time was obviously shorter[(18.33+2.31)min vs(22.80±3.02)min,P＜0.001].Conclusion Through precise CUSUM analysis of the learning curves obtained from 110 patients receiving CT-guided percutaneous lung biopsy,the results of this study indicates that it requires to accomplish 46 operations before a physician can skillfully master the technique of CT-guided percutaneous lung biopsy.

Objective:To validate the application value and safety of blunt-tip needle technique for computer tomography (CT)-guided percutaneous biopsy of pancreatic lesions.Methods:Clinical data of 103 patients with pancreatic lesions undergoing CT-guided percutaneous biopsy with blunt-tip needle approach in the First Affiliated Hospital of Zhengzhou University from October 2021 to October 2023 were retrospectively analyzed, including 64 males and 39 females, aged (61.5±12.3) years. According to the access routes, procedures were divided into regular group ( n=70) and hard-to-reach group ( n=33). Technical data such as the duration of procedure, number of needle correction scans, and the incidence of complications were recorded. The technical success rate, diagnostic yield, accuracy, sensitivity, specificity, and false-negative rates were compared between groups. Results:The overall technical success rate was 100%(103/103). According to postoperative pathology and clinical follow-ups, the final diagnosis of 103 patients was 98 cases with neoplastic lesions and 5 with non-neoplastic lesions. The overall diagnostic rate of percutaneous biopsy was 91.3%(94/103), with a false negative rate of 5.8%(6/103), sensitivity of 92.9%(90/98), and specificity of 100%(90/90). Duration of procedure [(22.8±6.3) min vs. (22.4±7.9) min], number of needle correction scans [5.0 (3.0, 6.0) times vs. 5.0 (4.0, 7.5) times], length of target access [(69.9±15.4) mm vs. (73.7±17.4) mm], diagnostic yield [90.0%(63/70) vs. 93.9%(31/33)], and accuracy rate [90.0%(63/70) vs. 93.9%(31/33)] were comparable between regular group and hard-to-reach group (all P>0.05). Complications occurred in 8 patients, including 5 patients with hemorrhage and 3 with pancreatitis, which were successfully managed with conventional therapy. The incidence of complications were similar between the hard-to-reach and regular group [9.1%(3/33) vs. 7.1%(5/70), χ2=0.12, P=0.730]. Conclusion:CT-guided percutaneous biopsy in the diagnosis of pancreatic lesions with blunt-tip needle approach has a satisfactory technical success rate, diagnostic yield, accuracy, and safety, which can be used in patients with hard-to-reach lesions.

Objective:To validate the application value and safety of blunt-tip needle technique for computer tomography (CT)-guided percutaneous biopsy of pancreatic lesions.Methods:Clinical data of 103 patients with pancreatic lesions undergoing CT-guided percutaneous biopsy with blunt-tip needle approach in the First Affiliated Hospital of Zhengzhou University from October 2021 to October 2023 were retrospectively analyzed, including 64 males and 39 females, aged (61.5±12.3) years. According to the access routes, procedures were divided into regular group ( n=70) and hard-to-reach group ( n=33). Technical data such as the duration of procedure, number of needle correction scans, and the incidence of complications were recorded. The technical success rate, diagnostic yield, accuracy, sensitivity, specificity, and false-negative rates were compared between groups. Results:The overall technical success rate was 100%(103/103). According to postoperative pathology and clinical follow-ups, the final diagnosis of 103 patients was 98 cases with neoplastic lesions and 5 with non-neoplastic lesions. The overall diagnostic rate of percutaneous biopsy was 91.3%(94/103), with a false negative rate of 5.8%(6/103), sensitivity of 92.9%(90/98), and specificity of 100%(90/90). Duration of procedure [(22.8±6.3) min vs. (22.4±7.9) min], number of needle correction scans [5.0 (3.0, 6.0) times vs. 5.0 (4.0, 7.5) times], length of target access [(69.9±15.4) mm vs. (73.7±17.4) mm], diagnostic yield [90.0%(63/70) vs. 93.9%(31/33)], and accuracy rate [90.0%(63/70) vs. 93.9%(31/33)] were comparable between regular group and hard-to-reach group (all P>0.05). Complications occurred in 8 patients, including 5 patients with hemorrhage and 3 with pancreatitis, which were successfully managed with conventional therapy. The incidence of complications were similar between the hard-to-reach and regular group [9.1%(3/33) vs. 7.1%(5/70), χ2=0.12, P=0.730]. Conclusion:CT-guided percutaneous biopsy in the diagnosis of pancreatic lesions with blunt-tip needle approach has a satisfactory technical success rate, diagnostic yield, accuracy, and safety, which can be used in patients with hard-to-reach lesions.

Objective To observe the efficacy and safety of CT-guided percutaneous biopsy of gastrointestinal space-occupying lesions.Methods Data of 116 patients with gastric,small intestinal or colorectal space-occupying lesions(totally 116 lesions)who underwent CT-guided percutaneous biopsy were retrospectively analyzed.The success rate of sampling was recorded.According to surgical pathology or follow-up results,the effectiveness of percutaneous biopsy,including the diagnostic sensitivity,specificity,accuracy and false negative rate were calculated.The impact of cavity wall thickness of the lesion(＜1 cm and≥1 cm),needle insertion depth(＜5 cm and≥5 cm)and puncture needle through gastrointestinal tract or not were observed and the related complications were recorded.Results All lesions were successfully sampled.The diagnostic sensitivity of percutaneous biopsy was 88.07%(96/109),with specificity of 100%(7/7),accuracy of 88.79%(103/116)and false negative rate of 11.93%(13/109).For lesions with cavity wall thickness≥1 cm and puncture needle insertion depth＜5 cm,the sensitivity and accuracy of puncture biopsy were higher(all P＜0.05),while the sensitivity and accuracy of puncture needle through gastrointestinal tract or not were not different(both P＞0.05).Slight bleeding around the lesions occurred in 12 cases(12/116,10.34%),but no other complications happened.Conclusion CT-guided percutaneous biopsy of gastrointestinal space-occupying lesions was effective and safe.

Objective:To explore the clinical efficacy of CT-guided 125I seed implantation in patients with oligometastatic non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) activating mutations (EGFRm+ ) without progression after first-line EGFR-tyrosine kinase inhibitors (TKIs) treatment. Methods:From January 2015 to January 2019, 89 eligible patients (38 males, 51 females; age: (62±11) years) in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. They were divided into 2 groups according to different treatment methods. The 125I seeds were implanted for oligometastatic lesions and/or primary tumors without progression after first-line EGFR-TKIs therapy in local consolidation treatment group (Group A, n=32). The maintenance treatment group (Group B, n=57) only received EGFR-TKIs until disease progression. The progression-free survival (PFS) and overall survival (OS) of the 2 groups were estimated by Kaplan-Meier curves, and were compared by using log-rank test. Complications in Group A were observed. Results:The follow-up time of the group A and group B were 36.5(31.0, 43.3) months and 30.0(24.0, 35.0) months respectively. The median PFS and OS in group A were 15.0(95% CI: 12.8-17.2 ) months and 37.0(95% CI: 33.9-40.1) months, both of which were significantly longer than those in group B (12.0(95% CI: 10.9-13.1) months and 31.0(95% CI: 28.9-33.1) months; χ2 values: 8.80, 7.15, P values: 0.003, 0.007). In Group A, the total incidence of complications in CT-guided 125I seed implantation was 21.9%(7/32), and the common complications and adverse events were pneumothorax and hemoptysis. Only 1 patient underwent chest tube insertion, and the rest were treated with conservative treatment. No operation related death occurred. Conclusion:CT-guided 125I seed implantation is safe and feasible for patients with EGFRm+ oligometastatic NSCLC without progression after first-line EGFR-TKIs treatment, and can prolong the PFS and OS of patients.

Objective:To compare and analyze the technical success rate and safety between computed tomography(CT)-percutaneous radiological gastrostomy (PRG) and percutaneous endoscopic gastrostomy (PEG).Methods:From January 2017 to January 2022, at the First Affiliated Hospital of Zhengzhou University, the data of 76 patients who underwent gastrostomy due to inability to eat orally were collected, including 38 patients in PEG group and 38 patients in CT-PRG group. Surgical outcomes and complications were compared between the PEG and CT-PRG groups. Surgical outcomes included technical success rate, operation time, postoperative body mass index and hospital stay; while complications included minor complications (such as perifistula infection, granulation tissue proliferation, leakage, pneumoperitoneum, fistula tube obstruction, fistula tube detachment and persistent pain) and serious complications (such as bleeding, peritonitis, colonic perforation and death within 30 d). Independent sample t test, chi-square test, and Fisher exact probability test were used for statistical analysis. Results:The technical success rate of CT-PRG group was higher than that of the PEG group (100.0%, 38/38 vs. 78.9%, 30/38), and the operation time was shorter than that of the PEG group ((17.16±8.52) min vs. (29.33±16.22) min), and the differences were statistically significant ( χ2=1.19, t=2.36; P=0.038 and 0.011). There were no significant differences in postoperative body mass index ((16.29±3.56) kg/m 2 vs. (16.12±3.17) kg/m 2) and hospital stay ((4.13±1.26) d vs. (3.52±1.13) d) between PEG group and CT-PRG group (both P>0.05). The incidence of minor complications in the PEG group was 42.1% (16/38), including 6 cases of perifistulal infection, 1 case of leakage, 5 cases of fistula tube obstruction, 1 case of fistula tube detachment, and 3 cases of persistent pain. The incidence of serious complications was 5.3% (2/38), including 1 case of bleeding and 1 case of colonic perforation. The incidence of minor complications in the CT-PRG group was 39.5% (15/38), including 5 cases of perifistula infection, 1 case of granulation tissue proliferation, 3 cases of pneumoperitoneum, 3 cases of fistula tube obstruction, 2 cases of fistula tube detachment, and 1 case of persistent pain. The incidence of serious complications was 0. There was no significant difference in the incidence of minor complications between the PEG group and the CT-PRG group ( P>0.05), while the incidence of serious complications in the CT-PRG group was lower than that of the PEG group, and the difference was statistically significant (Fisher exact probability test, P=0.043). Conclusion:PEG is a safe and effective method of gastrostomy, but for patients with esophageal obstruction, CT-PRG can be an effective supplement to PEG.

Objective:To compare the safety and clinical value of percutaneous computed tomography (CT)-guided fine-needle aspiration biopsy (CT-FNA) with CT-guided core-needle biopsy (CT-CNB) in diagnosis of pancreatic lesions.Methods:We retrospectively analyzed the clinical data of patients with pancreatic lesions who underwent percutaneous CT-guided biopsy from January 2017 to January 2022 at the First Affiliated Hospital of Zhengzhou University. A total of 454 patients (251 men, 203 women) were enrolled in this study with age of (60.5±11.6) years old. They were divided into the CT-FNA group ( n=300) and the CT-CNB group ( n=154) according to the biopsy method. The one-time diagnosis rate, accuracy, sensitivity, false negative rate and incidence rate of complications of the two groups were compared. Results:The one-time diagnosis rate and accuracy rate in the CT-CNB group were slightly higher than those in the CT-FNA group, but the differences were not statistically significant [92.2%(142/154) vs. 86.0%(258/300), χ 2=3.74, P=0.053; 97.4%(150/154) vs. 92.0%(276/300), χ 2=0.16, P=0.690]. Compared with the CT-FNA group, the CT-CNB group had a higher sensitivity and a lower false negative rate, and the differences were statistically significant [97.2%(138/142) vs. 91.5%(260/284), χ 2=4.89, P=0.036; 2.8%(4/142) vs. 8.5%(24/284), χ 2=4.89, P=0.036]. Common complications in the two groups were pain, hematoma and pancreatitis, and there was no statistically significant difference in the incidences of complication [9.0%(27/300) vs. 9.1%(14/154), χ 2<0.01, P=0.975]. Conclusions:Both CT-FNA and CT-CNB were safe for diagnosis of pancreatic lesions, with high diagnostic yields and with similar safety and accuracy. When compared with CT-FNA, CT-CNB has a higher sensitivity and a lower false negative rate.

Objective To discuss the safety and curative effect of CT -guided percutaneous argon -helium cryoablation in treating leiomyosarcoma. Methods A total of 25 patients with leiomyosarcoma, who were treated at authors' hospital during the period from January 2012 to January 2016, were included in this study. CT-guided percutaneous argon-helium cryoablation was performed in all patients. The local changes of target lesions, the progression - free survival (PFS) and the survival rate were dynamically checked, and the complications were recorded. Results CT examination performed immediately after argon- helium cryoablation indicated that radical frozen ablation was achieved in 13 patients (52％), significant tumor -reductive frozen ablation in 11 patients (44％), effective tumor-reductive frozen ablation in one patient (4％), and invalid tumor-reductive frozen ablation in 0 patient. Follow - up CT examination performed at 3 months after argon - helium cryoablation showed that, based on solid tumor evaluation criteria, complete remission (CR) was obtained in 14 patients, partial remission (PR) in 8 patients and stable disease (SD) in one patient, the total remission rate (CR+PR) was 88％. The local PFS time was (9. 4±6. 2) months. The one-, 2-and 3-year survival rates were 64％, 48％ and 32％ respectively. In this group of cases, neither serious complications such as haemorrhage or tumor lysis syndrome nor procedure-related death occurred. Postoperative mild and moderate complications included fever, skin frostbite, immediate postoperative local pain exacerbation, nerve damage, etc., all of which disappeared or became relived after symptomatic treatment. Conclusion For the treatment of leiomyosarcoma, CT-guided percutaneous targeted argon-helium cryoablation has certain and definite short-term curative effect. CT-guided argon-helium cryoablation is a safe, reliable and minimally-invasive treatment, this technique is worth popularizing in clinical practice. (J Intervent Radiol, 2018, 27:228-232)

Objective: To evaluate the feasibility and short-term effect of CT guided cryoablation for malignant chest wall or pleural involvement. Methods: To follow up 22 patients with chest wall or pleural involvement of various malignancies who underwent cryoablation from January 2012 to January 2015 by conducting postoperative 1-, 3- and 6-month enhanced CT, MRI or PET-CT examinations, respectively, evaluate local curative effect, and observe their progression-free survival (PFS), postoperative pain remission and complications after the cryoablation. Results: A total of 22 patients with 27 lesions received 26 times of argon-helium cryoablation. According to the coverage situation of immediate postoperative ice balls on the lesions, they were divided into a complete coverage group (Group A with 18 patients) and a partial coverage group (Group B with 4 patients). 1 month later, 15 patients′ tumors were completely ablated, and 3 had residue and thus received the second cryoablation in Group A, while all patients′ tumors had residue in Group B. 3 months later, 17 patients′ tumors were completely ablated, and 1 had residue and thus received another cryoablation in Group A, while all patients′ residual tumors enlarged in different extent in group B. 6 months later, all lesions were ablated in group A while all patients′ residual tumors enlarged in group B. For the 22 patients, their preoperative, and postoperative 1-week, 1-month, 3-month, and 6-month VAS scores were 4.95±0.57, 1.45±0.35, 1.45±0.35, 1.64±1.71, and 2.00±2.35, respectively. The differences in the preoperative, postoperative 1-week, and postoperative 1-month scores are significant statistically (P<0.05), and the difference in the postoperative 1-month and 6-month scores is also with statistical significance (P=0.03). For all patients, their post-operative 1-week, 1-month, 3-monte and 6-month pain remission rates are 90.9%(20/22), 90.9%(20/22), 86.4% (19/22)and 81.8%(18/22), respectively. With a median follow-up of 13.5 months, the median PFS is 7 months. The adverse effect after argon-helium cryoablation involved transitory worsened pain (16 cases), pleural effusion (5 cases, including 3 underwent closed drainage), fever (5 cases), and hemoptysis (3 cases). Conclusion CT guided argon-helium cryoablation is a safe and effective method to treat malignant chest wall or pleural involvement.

Objective To investigate the application of automatic biopsy gun in CT-guided percutaneous biopsy for the diagnosis of pulmonary sub-centimeter nodules (≤1 cm).Methods A total of 78 patients with pulmonary sub-centimeter nodules were enrolled in this study. Under CT guidance, percutaneous multi-point and multi-sampling puncture biopsy with automatic biopsy gun was carried out in all patients. The success rate of puncturing, the complications and pathological results were analyzed. Results The success rate of puncturing was 91.0% (71/78). The incidence of pneumothorax was 17.9% (14/78) and the incidence of hemorrhage was 30.8%(24/78). In all patients, no pulmonary infection, tumor tract seeding or metastasis was observed during the follow-up period. Among the 71 patients who had a successful biopsy, squamous cell carcinoma was detected in 7, adenocarcinoma in 25, small cell carcinoma in 5, metastatic lesion in 3, chronic interstitial lung inflammation in 13, granulomatous inflammation in 12, pulmonary fungus in 4, pneumoconiosis nodule in one and pulmonary hamartoma in one. Conclusion For CT-guided percutaneous puncture biopsy of pulmonary sub-centimeter nodules, the use of automatic biopsy gun is safe and reliable with higher success rate.