CT-guided biopsy of pulmonary nodules ≤10 mm: Diagnostic yield based on nodules' lobar and segmental distribution

Dominguez-Konicki, Lillian; Karam, Adib R.; Furman, Michael; Grand, David

doi:10.1016/j.clinimag.2020.04.040

Cited by 7 publications

(10 citation statements)

References 12 publications

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“…It can also be concluded that the biopsy needle yielded diagnostic material from the lesions in about 73% (74/101) of biopsies, which corresponds with other authors 7 . In a quarter of them, for various reasons, the procedure failed.…”

Section: Discussionsupporting

confidence: 89%

Biopsy of lung lesions under CT control

Marel¹,

Pádr²,

Fila³

et al. 2021

BIOMED PAP

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Objectives. With the increasing number of detected lung nodules and the need for morphological verification, the number of CT-controlled biopsies is increasing. The aim of this study was to assess the risks and benefits of these biopsies. Methods. This is a prospective and observational study. We evaluated 101 punctures performed on a group of 90 consecutive patients in the Department of Radiology. Results. In patients with a mean age of 66 years, with mostly accidentally detected lung nodules, we observed complications 38 times. The most common were minor pneumothoraxes or insignificant bleedings. In 6 patients, the complications were more serious, 5 times the pneumothoraxes required chest drainage, once massive hemoptysis was recorded. The lesions were successfully biopsied 78 times, the target was missed 23 times. The diagnosis of lung cancer (LC) was confirmed in 60 patients, 49 LCs were verified by puncture under CT control. 42% (25/60) of patients with LC were diagnosed in TNM stages I and II. 23% (14/60) of patients with LC were treated surgically. The remaining 30 patients most often suffered from lung metastazes (13/30), in 8 of them an inflammatory lung disease was diagnosed. 69 patients underwent bronchoscopy, in only 19% (13/69) it contributed to the diagnosis. In a model "screening like" group of 49 patients with only randomly detected lung deposits, we diagnosed LC in 76% (37/49). 49% (18/37) were in TNM stage I and II, 11 were treated surgically. Conclusions. CT-controlled biopsy of lung lesions is an effective and safe diagnostic method.

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Section: Discussionsupporting

confidence: 89%

Biopsy of lung lesions under CT control

Marel¹,

Pádr²,

Fila³

et al. 2021

BIOMED PAP

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“…For example, fiberoptic bronchoscopy with transbronchial biopsy is limited to larger, central lesions, and has a modest diagnostic yield (18-60%) [2]. Percutaneous CT guided biopsy provides the advantage of a 70-90% yield when targeting peripheral lesions, but this is highly dependent on location and size [3,4]. There are also adverse effects such as pneumothorax requiring intervention (1-15%), pulmonary hemorrhages (18%) and hemoptysis (4.1%) [3,5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Percutaneous CT guided biopsy provides the advantage of a 70-90% yield when targeting peripheral lesions, but this is highly dependent on location and size [3,4]. There are also adverse effects such as pneumothorax requiring intervention (1-15%), pulmonary hemorrhages (18%) and hemoptysis (4.1%) [3,5,6]. While the adverse effects are less with ENB (pneumothorax 3.2%, pulmonary hemorrhage 2.3%), and the overall diagnostic yield ranges from 59-77%, it is a technically challenging procedure without the ability to directly visualize the target [7,8].…”

Section: Introductionmentioning

confidence: 99%

Lung Nodule Evaluation Using Robotic-Assisted Bronchoscopy at a Veteran’s Affairs Hospital

Ekeke

Vercauteren

Istvaniczdravkovic

et al. 2021

JCM

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The incidence of lung nodules has increased with improved diagnostic imaging and screening protocols. Despite improvements for diagnosing pulmonary nodules with technologies such as electromagnetic navigational bronchoscopy (ENB), several limitations still exist including adequate visualization, localization, and diagnostic yield. Robotic-assisted bronchoscopy with ENB has been introduced as a method to overcome these shortcomings. We describe our initial experience in evaluating lung nodules with robotic assisted bronchoscopy. We retrospectively reviewed data on the first 25 patients that underwent robotic-assisted bronchoscopy and biopsy. We analyzed success with localization, diagnostic yield, and post procedural morbidity. Diagnostic yield was 96% (24/25) with no periprocedural morbidity. The majority of nodules were malignant or atypical (76%) and were located in the right upper lobe. Diameter ranged between 0.8–6.9 cm (median size 1–2 cm). Seventy-five percent of patients underwent subsequent treatment for cancer based on these results, with 25% having continued surveillance. Robotic assisted bronchoscopy is safe and accurate. Studies with larger numbers will allow better understanding of the diagnostic yield and clinical utility of this approach in comparison to other diagnostic tools for lung nodules.

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“…Investigators showed that among nodules smaller than 1 cm, diagnostic yield varied depending on lobar location, likely due to factors such as differential diaphragmatic excursion during respiration. [8] Here, we show this trend does not impact nodules when analyzed independent of size. In our study, the PPV was equally high across all lung lobes, roughly 85%.…”

Section: Discussionmentioning

confidence: 61%

“…[5,7] Investigators demonstrated that among nodules smaller than 1 cm, lobar distribution of nodules impacted diagnostic performance. [8] In this retrospective study, we sought to evaluate whether (1) diagnostic yield varied when lung lesions were stratified by location and (2) whether the trend of increased diagnostic performance with increased lesion size differed depending on their lobar distribution. Specifically, because respiratory motion affects lower lobe lesions to a greater extent than upper lobe lesions, we hypothesized that yield would be higher for lesions in the upper lobes and superior segments of the lower lobes relative to nodules in the right middle lobe, lingula and basal segments of the lower lobes.…”

Section: Introductionmentioning

confidence: 99%

CT-guided percutaneous lung biopsy: Correlation between diagnostic yield, lung lesion size, and lobar distribution

Wilson

Karam

Baird

et al. 2021

AJIR

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Objectives: The aim of this retrospective study was to investigate the relationship between lung lesion lobar distribution, lesion size, and lung biopsy diagnostic yield. Material and Methods: This retrospective study was performed between January 1, 2013, and April 30, 2019, on CT-guided percutaneous transthoracic needle biopsies of 1522 lung lesions, median size 3.65 cm (range: 0.5– 15.5 cm). Lung lesions were localized as follows: upper lobes, right middle lobe and lingual, lower lobes superior segments, and lower lobes basal segments. Biopsies were classified as either diagnostic or non-diagnostic based on final cytology and/or pathology reports. Results were considered diagnostic if malignancy or a specific benign diagnosis was established, whereas atypical cells, non-specific benignity, or insufficient specimen were considered non-diagnostic. Results: The positive predictive value (PPV) of a diagnostic yield was 85%, regardless of lobar distribution. Because all PPVs were relatively high across locations (84–87%), we failed to find statistically significant difference in PPV between locations (P = 0.79). Furthermore, for every 1 cm increase in target size, the odds of a diagnostic yield increased by 1.42-fold or 42% above 85%. Although target size increased the diagnostic yield differently by location (between 1.4- and 1.8-fold across locations), these differences failed to be statistically significant, P = 0.55. Conclusion: Percutaneous transthoracic needle biopsy of lung lesions achieved high diagnostic yield (PPV: 84– 87%) across all lobes. A 42% odds increase in yield was achieved for every 1 cm increase in target size. However, this increase in size failed to be statistically significant between lobes.

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CT-guided biopsy of pulmonary nodules ≤10 mm: Diagnostic yield based on nodules' lobar and segmental distribution

Cited by 7 publications

References 12 publications

Biopsy of lung lesions under CT control

Biopsy of lung lesions under CT control

Lung Nodule Evaluation Using Robotic-Assisted Bronchoscopy at a Veteran’s Affairs Hospital

CT-guided percutaneous lung biopsy: Correlation between diagnostic yield, lung lesion size, and lobar distribution

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