Biópsia percutânea transtorácica guiada por TC na avaliação de lesões pulmonares de natureza indeterminada

Abstract

CT-guided Percutaneous Transthoracic Biopsies (PTB) performed in the Radiology Department of Garcia de Orta Hospital between 2002 and 2004 to evaluate undetermined pulmonary lesions were retrospectively analysed. 89 fine needle aspiration biopsies (FNAB) and 13 core needle biopsies (CNB) were performed on 92 patients (67 men, mean age: 64.4 years). 82 lesions (89%) were nodular lesions (mean diameter: 3.8+/-1.7 cm, 65 peripheral). We did not observe complications among patients who underwent CNB; minor complications and pneumothorax requiring drainage occurred in 11 FNAB. 72 FNAB were considered adequate for cytology diagnosis; 72% of them positive for malignancy. All CNB were adequate and conclusive. From the 7 CNB performed on patients with previous FNAB, 3 allowed a better histological characterization and in 3 cases of inadequate FNAB, CNB was conclusive. All malignant lesions were nodules: 20 adenocarcinoma, 13 non-small cell lung cancer (SCLC), 10 epidermoid tumours, 5 small-cell lung cancer, 2 carcinoids, 1 bronchiolo alveolar carcinoma, 1 malignant mesothelioma and 8 metastasis. Unspecific/inflammatory lesions (n=5) were the most frequent benign lesions. Malignant lesions were more prevalent in older patients (p=0.007) and were larger (p=0.006). Spiculated and lobulated contour (p=0.05) were more prevalent in malignant lesions while regular contour was more frequent among benign lesions (p=0.0001). Gender, smoking, location, pleural tag, homogenous attenuation, cavitation, calcification, necrosis and air bronchogram did not differ significantly between benign and malignant nodules. This study shows that CT-guided PTB is a safe and effective procedure in the evaluation of undetermined pulmonary lesions.

Non-diagnostic Results of Percutaneous Transthoracic Needle Biopsy: A Meta-analysis

“…The pooled incidence rates of other pathology findings of PTNB specimens are shown in Fig. 2: specific malignancy, 68.4% (95% CI, 66.4–70.3%, I 2 = 0.93; 29739 biopsies in 122 studies) 3,4,6–9,11–23,25–70,72–76,78,79,81–86,88–93,96,98–105,108,110,113–115,118–121,124,126–130,132–134,137–147 ; atypical cells, 3.2% (95% CI, 2.6–3.9%, I 2 = 0.86; 11032 biopsies in 45 studies) 4,9,13,14,17–20,26,27,29,30,34,37,41,42,46,47,53,64,66,69,70,74–76,78,79,85,86,89–91,98,101,104,108,115,120,121,126,129,133,144,147 ; AAH, 1.6% (95% CI, 0.3–2.9%, I 2 = 0.49; 849 biopsies in 6 studies) 8,76,84,126,128,138 ; non-specific benign results, 14.2% (95% CI, 12.1–16.2%; I 2 = 0.95; 16455 biopsies in 67 studies) 4,6,8,11,12,19,22,23,…”

“…3). The pooled final malignancy rate of non-diagnostic results was 59.3% (95% CI, 51.7–66.8%; I 2 = 0.80, 709 biopsies in 47 studies) 4,6–8,11,12,19,22,23,26–28,33,34,38,40,42,45,48,52,54,55,59–61,65,70,72,76,78,79,81–83,85,91,92,96,101,108,115,129,137–140,147 . The malignancy rate was moderately positively correlated with the overall prevalence of malignancy in the study (correlation coefficient, 0.66; 95% CI, 0.42–0.91).

Figure 3Malignancy rate according to pathology reports of biopsy specimen in percutaneous thoracic needle biopsy.

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Biópsia aspirativa transtorácica por agulha fina guiada por TC de lesões pulmonares: resultados e complicações

“…(9,10,12) The accuracy of CT-guided needle biopsy in establishing a diagnosis of malignant lesions ranges from 70% to 100%. (7,9,10,(13)(14)(15)(16)(17)(18) The rate of false-positive results is typically below 4%. (7) In the present study, the accuracy of the procedure in establishing a diagnosis of malignant lesion was 91.5%, and the rate of false-positive results was 17.6% (3 cases), all cytological findings being suggestive of, but not confirming the atelectasis-free lung parenchyma as possible, thus reducing the risk of pneumothorax.…”

Métodos De Biópsia Pulmonar Empregados No Hospital Universitário De Santa Maria: Acurácia, Sensibilidade E Especificidade

“…Durante anos a PAAF foi o método de coleta mais utilizado, dado o receio de complicações acrescidas com o uso de agulhas mais grossas. Porém, estudos recentes demonstram uma incidência de complicações semelhante nas duas técnicas e uma maior acuidade diagnóstica da core biopsy em relação à PAAF sem citopatologista em sala, dada a obtenção de um fragmento histológico, o que tem contribuído para a sua generalização nos últimos anos 11 . A core biopsy apresenta uma acuidade superior no diagnóstico de lesões benignas (71% a 100%), permitindo mais freqüentemente um diagnóstico histológico específico.…”

“…A core biopsy apresenta uma acuidade superior no diagnóstico de lesões benignas (71% a 100%), permitindo mais freqüentemente um diagnóstico histológico específico. Assim, a BPPT guiada por TC assume-se como uma técnica de eleição em relação à biópsia transbrônquica na avaliação de lesões pulmonares indeterminadas, periféricas, ou centrais com broncoscopia negativa, apresentando uma reduzida morbidade e elevada acuidade diagnóstica 10,11,12 . A acurácia das biópsias aspirativas por agulha fina e por fragmentos de lesões pulmonares depende do tamanho da lesão e da colaboração do paciente.…”