Does needle size affect diagnostic yield of transthoracic needle biopsy in malignant pulmonary lesions?: Comparison of 18-, 22- and 25-gauge needles in surgical specimens

Abstract Background Transthoracic needle biopsy is a well-established technique for diagnosing pulmonary lesions. Computed tomography (CT) is usually used as guidance. Ultrasound (US)-guided biopsy is a relatively affordable modality for diagnosis of peripheral lung lesions (PLLs; also known as peripheral pulmonary lesions [PPLs]) and peripheral pleural lesions. Objectives The purpose of this study was to study the diagnostic yield of US guidance sampling a consecutive series of peripheral lung and pleural lesions and potential factors influencing the diagnostic yield with recording the occurrence of any complications. Patients and Methods This was a prospective study that was conducted at Ain Shams University Hospitals upon a population of 60 patients, during the period from September 2018 to August 2019. A special puncture transducer is used to perform US-guided biopsy with visualization of the biopsy needle and the lesion; facilitating the sampling procedure. Results The use of US-guided transthoracic needle biopsies across 60 patients was shown to have a yield of 75% which found the occurrence of 45 conclusive and 15 non-conclusive results From this study population, 70% (n = 42/45) were found to have malignant manifestations, of which 26 were undifferentiated high grade adenocarcinoma, and 9 were moderately differentiated adenocarcinoma. As for complications arising from the biopsy procedure, twenty percent 20% (n = 12) of patients suffered from complications in the form of hemoptysis in 8 which was controlled by hemostatic measures and 4 patients acquired pneumothorax, three (¾) of them received high flow oxygen and conservative treatment and only one (1/4) patient had intercostal tube placement. Diagnostic yield was significantly increased with the presence of Wedge shaped hypoechoic lesions(p < 0.001), hard Mass consistency was significantly highly associated with conclusive results (p < 0.001), as well as a significant link between the longitudinal diameter of masses that had a mean length of 45.05mm ±12.93mm (#x0003D; 0.029).It also showed that more biopsies taken were highly significant correlation with conclusive outcomes (p < 0.001). Conclusion US-guided biopsy is a robust and accurate procedure to effectively diagnose peripheral lung lesions, with a low incidence of complications and gradually improving results with the mastery of the procedure.

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Initial Experience in CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Lesions Performed by a Pulmonologist

Journal of Clinical Medicine ◽

10.3390/jcm8060821 ◽

2019 ◽

Vol 8 (6) ◽

pp. 821 ◽

Cited By ~ 2

Author(s):

June Hong Ahn ◽

Jong Geol Jang

Keyword(s):

Diagnostic Accuracy ◽

Complication Rate ◽

Predictive Value ◽

Needle Biopsy ◽

Diagnostic Yield ◽

Safe Procedure ◽

Transthoracic Needle Biopsy ◽

Ct Guided ◽

Lung Lesions ◽

Percutaneous Transthoracic Needle Biopsy

In the diagnosis of lung lesions, computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) has a high diagnostic yield and a low complication rate. The procedure is usually performed by interventional radiologists, but the diagnostic yield and safety of CT-guided PTNB when performed by pulmonologists have not been evaluated. A retrospective study of 239 patients who underwent CT-guided PTNB at Yeungnam University Hospital between March 2017 and April 2018 was conducted. A pulmonologist performed the procedure using a co-axial technique with a 20-gauge needle. Then diagnostic yield and safety were assessed. The overall sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of malignancy were 96.1% (171/178), 100% (46/46), 100% (171/171), and 86.8% (46/53), respectively. The diagnostic accuracy was 96.9% (217/224) and the overall complication rate was 33.1% (82/248). Pneumothorax, hemoptysis, and hemothorax occurred in 27.0% (67/248), 5.2% (13/248), and 0.8% (2/248) of the patients, respectively. Univariate analyses revealed that pneumothorax requiring chest tube insertion was a significant risk factor (odds ratio, 25.0; p < 0.001) for diagnostic failure. CT-guided PTNB is a safe procedure with a high diagnostic accuracy, even when performed by an inexperienced pulmonologist. The results were similar to those achieved by interventional radiologists as reported in previously published studies.

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Endobronchial ultrasonography with guide sheath versus computed tomography guided transthoracic needle biopsy for peripheral pulmonary lesions: a propensity score matched analysis

Journal of Thoracic Disease ◽

10.21037/jtd.2016.09.52 ◽

2016 ◽

Vol 8 (10) ◽

pp. 2758-2764 ◽

Cited By ~ 6

Author(s):

Chong Wang ◽

Xiao Li ◽

Zuli Zhou ◽

Hui Zhao ◽

Zhixin Li ◽

...

Keyword(s):

Computed Tomography ◽

Propensity Score ◽

Needle Biopsy ◽

Transthoracic Needle Biopsy ◽

Pulmonary Lesions ◽

Endobronchial Ultrasonography ◽

Peripheral Pulmonary Lesions

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FNA and CNB in the Diagnosis of Pulmonary Lesions: A Single-center Experience on 665 Patients, Comparison between Two Periods

Tumori Journal ◽

10.5301/tj.5000633 ◽

2017 ◽

Vol 103 (4) ◽

pp. 360-366 ◽

Cited By ~ 2

Author(s):

Alfonso Vittorio Marchianò ◽

Maria Cosentino ◽

Giuseppe Di Tolla ◽

Francesca Gabriella Greco ◽

Mario Silva ◽

...

Keyword(s):

Needle Biopsy ◽

Diagnostic Yield ◽

Needle Aspiration ◽

Complication Rates ◽

Multivariate Logistic Regression ◽

Ct Guided ◽

Fine Needle ◽

Pulmonary Lesions ◽

Single Center Experience ◽

Lung Biopsies

Purpose To evaluate the diagnostic yield and complication rate of 2 different biopsy techniques (fine-needle aspiration, FNA, and core-needle biopsy, CNB) in the diagnosis of pulmonary lesions in 2 distinct periods, 2010-2012 and 2013-2015. Methods We retrospectively analyzed the results of 691 CT-guided lung biopsies in 665 patients who were divided into 2 groups: cohort 1 (January 2010 to December 2012) was composed of 271 consecutive patients with 284 procedures either by FNA or CNB; cohort 2 (January 2013 to December 2015) was composed of 394 patients with 407 CNBs. Univariate and multivariate logistic regression modeling was used for selected outcomes including diagnostic yield, bleeding and pneumothorax. Results Cohort 1 comprised 165 men and 106 women (mean age 68.5 years) with 180 FNAs and 104 CNBs; cohort 2 comprised 229 men and 165 women (mean age 66.4 years) with 407 CNBs. The diagnostic yield increased in cohort 2 with respect to cohort 1. There was a slight increase in CT procedure complications (pneumothorax and bleeding) from cohort 1 to cohort 2. The overall risk of complications was greater for lesions <20 mm and for lesions at >20 mm distance from the pleura. Conclusions CT-guided CNB had a higher diagnostic yield than discretional use of either FNA or CNB; there was a slight but acceptable increase in complication rates.

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