CT-guided fine-needle aspiration biopsy of solitary pulmonary nodules under 15 mm in diameter: time for an afterthought?

Abstract

Background: Many studies on fine-needle aspiration biopsy (FNAB) for undetermined pulmonary nodules reported that diagnostic accuracy tended to decline, whereas complication prevalence raised as the size of nodule decreased. Reconsideration on the effectiveness of FNAB would be appropriate considering the dramatic increase in the identification of small nodules with screening programs and new demands of target therapies. The aim of this study was to verify the efficacy of FNAB in pulmonary nodules smaller than 15 mm. Methods: A retrospective, cohort study was conducted on patients with undetermined solitary pulmonary nodules (SPNs) who underwent computer tomography (CT) guided FNAB at our Institution from January 2012 to December 2014. Patients with SPNs with diameter up to 15 mm were considered; inclusion criteria comprised ASA 3, FEV1 <70% of predicted, cardiac comorbidity or previous chest surgery. FNAB diagnostic performance and clinical efficacy were calculated. Results: Out of 225 patients referred for FNAB, 68 covered inclusion criteria. Forty-nine out of 68 smears (72%) were adequate for diagnosis. Specificity was 100% (95% CI: 77-100%), sensitivity was 100% (95% CI: 90-100%). Positive and negative predictive values were 1.0 (95% CI: 0.9-1.0) and 1.0 (95% CI: 0.77-1.0) respectively. A post-biopsy pneumothorax was detected in 27 cases (39%); the pneumothorax rate was significantly affected by the number of passages (P=0.01). Conclusions: The satisfactory results of our study lead to reconsidering FNAB in patients with pulmonary nodules below 15 mm in diameter, especially in order to avoid unnecessary surgery.

Diagnostic value of intraoperative fine‐needle aspiration cytologic diagnosis versus frozen section‐based histopathologic diagnosis in thoracic malignancies: A single institution's experience

“…Decreased diagnostic accuracy and increased risk of complications has been reported when FNA is used to evaluate lung lesions <15 mm. 20 Small pulmonary lesions can be overlooked on FS evaluation, especially if they are not palpable.…”

Computed tomography-guided core needle biopsy for sub-centimeter pulmonary nodules

“…The minimal invasiveness and high precision of CT-guided biopsy have established this technique as the preferred method for the diagnosis of pulmonary diseases [11][12][13][14][15][16][17][18].…”

Melanoma-associated antigen A1 and A3 as new candidate of diagnostic for non-small cell lung cancer

“…In patients with suspected lung cancer, routine invasive procedures namely taking biopsy samples are required for diagnosis [1,2]. These biopsy samples can be taken from outside the chest cavity (transthoracic) such as Fine Needle Aspiration Biopsy (FNAB) and core biopsy (CB) with either ultrasound or CT-scan guidance, as well as from invasive examinations through the airway (transbronchial) from bronchoscopy (aspiration biopsy, forceps biopsy, brushing, and bronchoalveolar lavage) [3,4]. But the sensitivity is still relatively low, especially in the early stages (63%) [5].…”