Computed Tomography-Guided Transthoracic Needle Biopsy: Predictors for Diagnostic Failure and Tissue Adequacy for Molecular Testing

Abstract

Background: Adequate and representative tissue from lung tumor is important in the era of precision medicine. The aim of this study is to identify detailed procedure-related variables and factors influencing diagnostic success and tissue adequacy for molecular testing in CT-guided TTNB.Methods: Consecutive patients undergoing CT-guided TTNB were retrospectively enrolled between January 2013 and May 2020. Multivariate analysis was performed for predictors for diagnostic accuracy and tissue adequacy for molecular testing. Logistic regression was used to identify risk factors for procedure-related complications.Results: A total of 2,556 patients undergoing CT-guided TTNB were enrolled and overall success rate was 91.5% (2,338/2,556). For lung nodules ≤3 cm, predictors for diagnostic success included coaxial needle use [OR = 0.34 (0.16–0.71), p = 0.004], CT scan slice thickness of 2.5 mm [OR = 0.42 (0.15–0.82), p = 0.011] and additional prefire imaging [OR = 0.31 (0.14–0.68), p = 0.004]. For lung tumor >3 cm, ground glass opacity part more than 50% [OR = 7.53 (2.81–20.23), p < 0.001] or presence of obstructive pneumonitis [OR = 2.31 (1.53–3.48), p < 0.001] had higher risk of diagnostic failure. For tissue adequacy, tissue submitted in two cassettes (98.9 vs. 94.9%, p = 0.027) was a positive predictor; while male (5.7 vs. 2.5%, p = 0.032), younger age (56.61 ± 11.64 vs. 65.82 ± 11.98, p < 0.001), and screening for clinical trial (18.5 vs. 0.7%, p < 0.001) were negative predictors.Conclusions: Using a coaxial needle, with thin CT slice thickness (2.5 mm), and obtaining additional prefire imaging improved diagnostic success, while obtaining more than two tissue cores and submitting in two cassettes improved tissue adequacy for molecular testing.

Low-dose versus standard-dose computed tomography-guided core needle biopsy for lung nodules: a randomized controlled trial

“…However, we did not nd any risk factors which were associated with diagnostic failure. In past investigations regarding CTguided CNB, the risk factors of diagnostic failure usually encompassed less sample tissues and larger lesion size [9,12,21,22]. In this study, we used the co-axial technique and obtained 3-4 samples from each LN, therefore, the number of sample tissues did not interfere the diagnostic accuracy.…”

CT Guided TTNA and Core Biopsy in Suspected Lung Cancer, Review of Cases in Adam Malik General Hospital, Medan

“…Core Biopsy due to a larger needle. 18,19 This study included 42 samples. From all the samples, the majority gender is male, 30 patients (71.4%).…”

Lung, Pleural, and Mediastinal Biopsies: From Preprocedural Assessment to Technique and Management of Complications

“…26 Moreover, in the age of precision medicine, core biopsies allow for the characterization of tumor genomics which plays an increasingly important role in patient management. A recent study has shown that obtaining more than two core samples, and submitting samples in two cassettes improved tissue adequacy for molecular testing, 27 the latter of which is part of our routine practice.…”