Computed tomography-guided cutting needle biopsy of pulmonary lesions

Abstract

PURPOSE:To report the experience of a radiology department in the use of computed tomography -guided cutting needle biopsy of pulmonary nodules, by evaluating diagnostic yield and incidence of complications.METHODS: This is a retrospective analysis of 52 consecutive patients who underwent lung lesion biopsy guided by computed tomography, performed between May 1997 and May 2000. Thirty-five patients were male and 17 were female, with ages ranging from 5 to 85 years (median, 62 years). The size of the lesions ranged from 1.8 to 15 cm (median, 5.4 cm).RESULTS: In a total of 52 biopsies of lung lesions, 51 biopsies (98.1%) supplied appropriate material for histopathological diagnosis, with 9 diagnosed (17.3%) as benign and 42 (80.8%) as malignant lesions. Specific diagnosis was obtained in 44 (84.6%) biopsies: 4 benign (9.1%) and 40 (90.9%) malignant lesions. The sensitivity, specificity, and accuracy of the cutting needle biopsies for determining presence of malignancy were 96.8%, 100%, and 97.2%, respectively. Complications occurred in 9 cases (17.3%), including 6 cases (11.5%) of small pneumothorax, 1 (1.9%) of hemoptysis, 1 (1.9%) of pulmonary hematoma, and 1 (1.9%) of thoracic wall hematoma. All had spontaneous resolution. There were no complications requiring subsequent intervention. CONCLUSION:The high sensitivity and specificity of the method and the low rate of complications have established cutting needle biopsy as an efficient and safe tool for the diagnosis of lung lesions. In our hospital, cutting needle biopsy is considered a reliable procedure for the evaluation of indeterminate pulmonary nodules.

Biópsias de lesões pulmonares com agulha grossa guiadas por tomografia computadorizada: a experiência de um centro oncológico

“…Yu et al (5) have demonstrated that core needles, either with or without the coaxial system, provide appropriate specimens (98.1%) for histological analysis and specific diagnosis, with an accuracy of 97.2%, sensitivity of 96.8% and specificity of 100% in the identification of malignant lesions. Chojniak et al…”

“…However, in the case of benign lesions, the accuracy of such method is lower than that with malig-nant lesions and, considering the difficulty in maintaining a pathologist on duty in the department of radiology, it was detected the necessity of performing biopsies to provide appropriate material for analysis and specific diagnosis (4) . Computed tomographyguided core-needle biopsy of lung lesions has been widely accepted as an effective and safe procedure for specific diagnosis (5,6) . By means of such a procedure, tissue fragments are collected for histological analysis in order to determine the specific nature of lung lesions.…”

Core needle biopsy in benign lung lesions: pathologic findings in 159 cases

“…Those that have examined CNB alone have concentrated on clinical features such as complication rates, radiographic characteristics or procedural techniques [5][6][7][8][9]. None have provided details of the pathologic findings.…”

“…A mean of 4.2 cores was submitted per biopsy (range, [1][2][3][4][5][6][7][8][9][10][11], and the mean combined length of all cores per biopsy was 1.7 cm (range, 0.2-4.4 cm). Biopsies with 3 or more cores were significantly more likely to yield a specific diagnosis (P = .002; two-tailed, unpaired t test) ( Table 1) in that a specific diagnosis was found in 82.5% of cases containing greater than 3 cores compared to 54.5% when there were less than 3 cores.…”

“…While previous series of CNB of lung have included benign diagnoses [1][2][3][4][5][6][7][8][9][10][11][12], none provide details of the histological features. The purpose of this study is to determine the types of benign diagnoses that can be appreciated on CNB with in-depth analysis of pathologic features and to assess factors that may influence diagnostic accuracy.…”