Coaxial technique-promoted diagnostic accuracy of CT-guided percutaneous cutting needle biopsy for small and deep lung lesions

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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P1-085: Factors affecting diagnostic accuracy of ct-guided transthoracic needle biopsy of lung lesions: results of 660 consecutive procedures

Journal of Thoracic Oncology ◽

10.1097/01.jto.0000283700.72345.24 ◽

2007 ◽

Vol 2 (8) ◽

pp. S583-S584

Author(s):

Adriano M. Priola ◽

Sandro M. Priola ◽

Silvia Novello ◽

Aldo Cataldi ◽

Luca Errico ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Needle Biopsy ◽

Transthoracic Needle Biopsy ◽

Ct Guided ◽

Lung Lesions ◽

Factors Affecting

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CT-guided cutting needle biopsy of lung lesions—An effective procedure for adequate material and specific diagnose

European Journal of Radiology ◽

10.1016/j.ejrad.2010.09.038 ◽

2011 ◽

Vol 80 (3) ◽

pp. e488-e490 ◽

Cited By ~ 16

Author(s):

Marcos Duarte Guimaraes ◽

Marcony Queiroz de Andrade ◽

Alexandre Calabria da Fonte ◽

Rubens Chojniak ◽

Jefferson Luiz Gross

Keyword(s):

Needle Biopsy ◽

Effective Procedure ◽

Ct Guided ◽

Lung Lesions ◽

Cutting Needle

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CT-guided transthoracic needle biopsy of pulmonary lesions: comparison between the cutting needle and aspiration needle

British Journal of Radiology ◽

10.1259/bjr.20190930 ◽

2020 ◽

pp. 20190930

Author(s):

Zhen-guo Huang ◽

Hong-liang Sun ◽

Cun-li Wang ◽

Bao-xiang Gao ◽

He Chen ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Complication Rate ◽

Needle Biopsy ◽

Final Diagnosis ◽

Benign Lesions ◽

Transthoracic Needle Biopsy ◽

Ct Guided ◽

Pulmonary Lesions ◽

Severe Hemorrhage ◽

Cutting Needle

Objectives: To compare CT-guided transthoracic cutting needle biopsy (TCNB) with transthoracic aspiration needle biopsy (TANB) for pulmonary lesions with respect to the diagnostic accuracy and complication rate. Methods: Of the 859 cases that underwent consecutive CT-guided biopsy of pulmonary lesions, 713 cases confirmed by surgical pathology or clinical follow-up were enrolled. Of these, the first consecutive 275 cases underwent TANB, and the remaining 438 received TCNB. The final diagnosis determined the accuracy of biopsy. Based on the post-biopsy CT and clinical medical records, the presence or absence of biopsy-related complications was determined. The χ2 test was used to compare the differences between TCNB and TANB in terms of diagnostic accuracy and complication rate. Results: Among the 713 biopsy lesions, the final diagnosis was malignant in 411 cases and benign in 302 cases. As compared to TANB, the diagnostic accuracy of TCNB (98.9% vs 93.8%, χ2 = 14.35, p < 0.01), sensitivity to malignant lesions (97.8% vs 90.6%, χ2 = 10.58, p < 0.01), negative predictive value (97.6% vs 84.8%, χ2 = 19.03, p < 0.01), and specific diagnostic rate for benign lesions (73.4% vs 57.9%, χ2 = 7.29, p < 0.01) were improved. On the other hand, a statistical difference was detected between TCNB and TANB with respect to the incidence of pneumothorax (20.6% vs 13.1%, χ2 = 6.46, p = 0.01), hemorrhage (32.2% vs 13.1%, χ2 = 33.03, p < 0.01), and hemoptysis (8.2% vs 3.3%, χ2 = 6.87, p < 0.01). One patient died just several minutes after TCNB due to severe hemorrhage with hemoptysis. Conclusions: Compared to TANB, CT-guided TCNB improves the diagnostic accuracy of pulmonary lesions, but complication rate increases significantly. Advances in knowledge: In general, TCNB should be recommended, especially for highly suspicious benign lesions. For patients with small lesions adjacent to vessels or vessels within the lesion, TANB should be considered.

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Accuracy of CT-guided transthoracic needle biopsy of lung lesions: Results of 612 consecutive procedures

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.18022 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 18022-18022

Author(s):

U. Ricardi ◽

A. M. Priola ◽

S. M. Priola ◽

S. Novello ◽

A. Cataldi ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Needle Biopsy ◽

Inflammatory Cells ◽

Final Diagnosis ◽

Needle Aspiration ◽

Lesion Size ◽

Maximum Diameter ◽

Transthoracic Needle Biopsy ◽

Ct Guided ◽

Lung Lesions

18022 Background: CT-guided transthoracic needle biopsy (TNB) is commonly used in diagnostic work-up of lung lesions. The availability of a on-site pathologist at the time of the procedure ameliorate its sensitivity, reduce the number of biopsies and false negatives. Methods: 612 procedures (608 patients with a CT-documented central or peripheral pulmonary lesion) performed at S. Luigi Hospital between November 2002 and August 2005 were prospectively analyzed; 66% males, median age was 66 years (range 29–87). Ineligibility criteria for the procedure included severe coagulopathy, previous contralateral pneumonectomy, lesions with a maximum diameter less than 5 mm or the impossibility to understand the procedure or to maintain the clinostatism for the time of the procedure. The on-site pathologist assigned to each specimen a semiquantitative score: 0 for bloody sample without other cells, 1 for aspecific benign or inflammatory cells, 2 for malignant cells without histotype characterization and 3 for well established benign or malignant histotype. Results: Most of the procedures was performed by fine needle aspiration biopsy, while in a minority of cases a tru-cut biopsy was requested. In 57.2% of the cases a single transthoracic access (range 1–4) was used and in 31% the procedure was repeated on the basis of the radiologist/pathologist judgment. In 154 patients a surgical resection was subsequently performed, while 454 were patients non-surgical. A score of 3 was obtained in 71% of cases (88% malignancies), 2 in 12.5%, 1 in 7.5% and 0 in 9%. A definitive diagnosis was made in 83.5% of procedures, while a score of 0–1 was assigned in 101 cases. Among 458 malignancies there were 411 lung cancer, 7 non-epithelial cancers and 40 metastases with only 1 false positive. The diagnostic accuracy for benign and malignant lesions was 67% and 92%, respectively (Pearson’s test p<0.005) with overall diagnostic accuracy of 83.3%. The variables affecting diagnostic accuracy were final diagnosis (benign 67%, malignant 92%, p<0.001) and lesion size (lesion 5 cm 78%, p<0.05). The presence of cavitation or necrotic areas and location of the lesion didn’t affect the diagnostic accuracy. Conclusion: In consecutive cases of CT-guided TNB final diagnosis and lesion size affect diagnostic accuracy. No significant financial relationships to disclose.

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