Radiologic and histopathologic features of hydrogel sealant after lung resection in participants of a prospective randomized clinical trial

• Published in: Clinical imaging Vol. 95; pp. 92 - 96
• Main Authors: Moussa, Amgad M., Hui, Yiang, Araujo Filho, Jose A., Muallem, Nadim, Li, Duan, Jihad, Marwah, Hsu, Meier, Moskowitz, Chaya S., Travis, William D., Solomon, Stephen B., Ginsberg, Michelle S., Maybody, Majid
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2023
• Subjects: CT guided lung biopsy; Humans; Hydrogel sealant; Hydrogels - therapeutic use; Lung - pathology; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Plug; Pneumothorax; Prospective Studies; Tomography, X-Ray Computed - methods; Tract sealant; Plug; CT guided lung biopsy; Tract sealant; Pneumothorax; Hydrogel sealant
• ISSN: 0899-7071; 1873-4499
• DOI: 10.1016/j.clinimag.2022.12.008

To summarize imaging and histopathologic characteristics of hydrogel sealant (plug) in lung parenchyma and assess their correlation with time since deployment of sealant.
Among a total of 208 participants randomized to the hydrogel sealant arm of a lung biopsy prospective randomized clinical trial, 51 underwent resection of the biopsied lesion. In 34 participants sealant material was present on histopathologic sections (n = 22), or they had cross-sectional imaging of chest between biopsy and resection (n = 23) or they had both imaging and histopathology (n = 11). Histopathologic and imaging findings were described. The association of these findings with time since sealant deployment was evaluated using the Wilcoxon rank sum test.
The mean time since sealant deployment for histopathology was 45.7 days (median 36, range 14–181) and for imaging studies was 99 days (median 32, range 4–527). The sealant was infiltrated by inflammatory cells in 20 (91%) participants. The main general histopathologic pattern of sealant was foamy in 12 (57%) and mesh in 8 (38%) participants. Imaging appearance of sealant was serpiginous in 18 (60%), linear in 10 (33%) or lobulated in 2 (6.7%) participants. In 2 participants the sealant was hypermetabolic with no histopathologic evidence of tumor. No correlation was found between time since sealant deployment and imaging or histopathologic appearances.
Hydrogel sealant appears as a serpiginous, linear, or lobulated opacity on cross-sectional imaging which can be metabolically active. It is associated with an inflammatory reaction with a foamy or mesh general pattern on histopathological assessment. No correlation was found between time since sealant deployment and imaging or histopathologic appearances.
•Hydrogel plugs used after lung biopsies will likely be encountered more frequently.•It is important to know the imaging and histological appearance of hydrogel plugs.•On imaging, hydrogel plugs are described as linear, serpiginous or lobular.•On histology, hydrogel plugs are described as foamy or mesh-like.•Hydrogel plugs did not affect tumor staging.