CT-guided percutaneous fine-needle aspiration biopsy of pulmonary nodules measuring 10 mm or less

Ng, Yuen Li; Patsios, Demetris; Roberts, Heidi C.; Walsham, Anna; Paul, Narinder; Chung, Taebong; Herman, Stephen J.; Weisbrod, Gordon L.

doi:10.1016/j.crad.2007.09.003

Cited by 89 publications

(74 citation statements)

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“…For small lung nodules, the diagnostic accuracy of CT-guided PCNB has been reported to be 79%-88% (6, 9). Several studies have also reported decreased diagnostic accuracy in the range of 52%-88% for smaller lesions (3,(6)(7)(8). In this study, the diameters of the small nodules ranged between 5-10 mm and had a mean diameter of 9 mm.…”

Section: Discussionmentioning

confidence: 73%

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Percutaneous core needle biopsy for small lung nodules with diameters ≤ 10 mm: accurate diagnosis and complication rates

Jae

June²,

Yie³

et al. 2012

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE To evaluate accurate diagnosis and complication rates of percutaneous core needle biopsy (PCNB) with an automated gun for small lung nodules that are 10 mm or less in diameter. MATERIALS AND METHODSForty-two cases of small lung nodules with diameters ≤10 mm (mean diameter, 9 mm) that received a PCNB were included in this study. Imaging guidance was fluoroscopy in 30 cases and computed tomography (CT) in 12 cases. RESULTSAccurate diagnosis was achieved with the initial PCNB in 88.1% (37/42) of cases. Accurate diagnosis rates were 86.7% (26/30) with fluoroscopic guidance and 91.7% (11/12) with CT guidance (P > 0.05). The complication rate of PCNB was 7.1% (3/42), including hemoptysis (n=2) and pneumothorax (n=1). The complication rate was 6.7% (2/30) with fluoroscopic guidance and 8.3% (1/12) with CT guidance (P > 0.05).CONCLUSION PCNB with an automated gun is useful for the pathologically conclusive diagnosis of small lung nodules (≤10 mm in diameter) using fluoroscopic or CT guidance. Key words: • X-ray computed tomography • fluoroscopy • lung diseases • biopsyP ercutaneous core needle biopsy (PCNB) of the lung is a well-established method for the cytological diagnosis of pulmonary nodules (1, 2). PCNB is generally regarded as a safe procedure with limited morbidity and extremely rare mortality (2-5). Biopsies of pulmonary lesions as small as 3 mm in diameter have been reported (6, 7). Diagnostic accuracy rates of 90%-100% using computed tomography (CT) guidance have been documented for pulmonary lesions greater than 10 mm in diameter (3,8). For smaller lesions, however, several studies have reported decreased diagnostic accuracy in the range of 52%-88% (3, 8, 9). Moreover, no study has reported a pathologically conclusive diagnosis of PCNB for small lung nodules using CT and fluoroscopy guidance.The purpose of this study was to evaluate the accurate diagnosis and complication rates of PCNB using an automated gun for small lung nodules with diameters <10 mm. Materials and methods PatientsBetween July 2004 and October 2011, 1467 consecutive percutaneous thoracic biopsies using automated biopsy devices or fine needle aspiration were performed at our institution. Of these cases, 81 extrapulmonary thoracic lesions, such as mediastinal (n=45), chest wall (n=21), and pleural (n=13) lesions were excluded. The remaining 1386 cases of PCNB were performed on pulmonary parenchymal lesions. The enrolled population consisted of 875 males (63.1%) and 511 females (36.9%). Patients' age ranged from 8 to 88 years (mean, 66.2 years). Using axial CT scan images, the largest transverse cross-sectional diameter of each nodule was measured on picture archiving and communication system workstations. The mean diameter of each nodule was considered as its size.Of the 1386 evaluable cases, there were 52 cases of initial PCNB and 10 cases of fine needle aspiration for small nodules with diameters <10 mm. Of these cases, 42 patients receiving an initial PCNB were enrolled in this study. The enrolled group consisted...

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Section: Discussionmentioning

confidence: 73%

“…PCNB is generally regarded as a safe procedure with limited morbidity and extremely rare mortality (2)(3)(4)(5). Biopsies of pulmonary lesions as small as 3 mm in diameter have been reported (6,7). Diagnostic accuracy rates of 90%-100% using computed tomography (CT) guidance have been documented for pulmonary lesions greater than 10 mm in diameter (3,8).…”

mentioning

confidence: 99%

Percutaneous core needle biopsy for small lung nodules with diameters ≤ 10 mm: accurate diagnosis and complication rates

Jae

June²,

Yie³

et al. 2012

Diagn Interv Radiol

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“…FNAB can only yield the cytological features of lesions rather than the histopathological results of lesions. It has been reported Original Article CT-guided transthoracic core needle biopsy for small pulmonary lesions: diagnostic performance and adequacy for molecular testing that the diagnostic accuracy of FNAB is decreased for small lesions (3,4). CT-guided transthoracic needle biopsy is a safe technology that is easy to operate, with a diagnostic accuracy for pulmonary lesions that reaches 64-97% (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

CT-guided transthoracic core needle biopsy for small pulmonary lesions: diagnostic performance and adequacy for molecular testing

Tian¹,

Wang²,

Li³

et al. 2017

J. Thorac. Dis.

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Background: Computed tomography (CT)-guided transthoracic needle biopsy is a well-established, minimally invasive diagnostic tool for pulmonary lesions. Few large studies have been conducted on the diagnostic performance and adequacy for molecular testing of transthoracic core needle biopsy (TCNB) for small pulmonary lesions.Methods: This study included CT-guided TCNB with 18-gauge cutting needles in 560 consecutive patients with small (≤3 cm) pulmonary lesions from January 2012 to January 2015. There were 323 males and 237 females, aged 51.8±12.7 years. The size of the pulmonary lesions was 1.8±0.6 cm. The sensitivity, specificity, accuracy and complications of the biopsies were investigated. The risk factors of diagnostic failure were assessed using univariate and multivariate analyses. The sample's adequacy for molecular testing of non-small cell lung cancer (NSCLC) was analyzed.Results: The overall sensitivity, specificity, and accuracy for diagnosis of malignancy were 92.0% (311/338), 98.6% (219/222), and 94.6% (530/560), respectively. The incidence of bleeding complications was 22.9% (128/560), and the incidence of pneumothorax was 10.4% (58/560). Logistic multivariate regression analysis showed that the independent risk factors for diagnostic failure were a lesion size ≤1 cm [odds ratio (OR), 3.95; P=0.007], lower lobe lesions (OR, 2.83; P=0.001), and pneumothorax (OR, 1.98; P=0.004). Genetic analysis was successfully performed on 95.45% (168/176) of specimens diagnosed as NSCLC. At least 96.8% of samples with two or more passes from a lesion were sufficient for molecular testing. Conclusions:The diagnostic yield of small pulmonary lesions by CT-guided TCNB is high, and the procedure is relatively safe. A lesion size ≤1 cm, lower lobe lesions, and pneumothorax are independent risk factors for biopsy diagnostic failure. TCNB specimens could provide adequate tissues for molecular testing.

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“…Although the identification of pulmonary nodules could be effectively accomplished by many imaging modalities, including high-resolution CT, positron emission tomography (PET/CT), and bronchoscopy, whereas the identification of lesions with GGO remains difficult. Thus, more reliable diagnosis and therapeutic options for uncertain pulmonary nodules are still in need (3).…”

Section: Introductionmentioning

confidence: 99%

Semi-rigid single hook localization the best method for localizing ground glass opacities during video-assisted thoracoscopic surgery: re-aerated swine lung experimental and primary clinical results

et al. 2017

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Background: The aim of this study was to compare the effects of currently available preoperative localization methods, including semi-rigid single hook-wire, double-thorn hook-wire, and microcoil, in localizing the pulmonary nodules, thus to select the best technology to assist video-assisted thoracoscopic surgery (VATS) for small ground glass opacities (GGO).Methods: Preoperative CT-guided localizing techniques including semi-rigid single hook-wire, doublethorn hook-wire and microcoil were used in re-aerated fresh swine lung for location experiments. The advantages and drawbacks of the three positioning technologies were compared, and then the most optimal technique was used in patients with GGO. Technical success and post-operative complications were used as primary endpoints.Results: All three localizing techniques were successfully performed in the re-aerated fresh swine lung.The median tractive force of semi-rigid single hook wire, double-thorn hook wire and microcoil were 6.5, 4.85 and 0.2 N, which measured by a spring dynamometer. The wound sizes in the superficial pleura, caused by unplugging the needles, were 2 mm in double-thorn hook wire, 1 mm in semi-rigid single hook and 1 mm in microcoil, respectively. In patients with GGOs, the semi-rigid hook wires localizations were successfully performed, without any complication that need to be intervened. Dislodgement was reported in one patient before VATS. No major complications related to the preoperative hook wire localization and VATS were observed. Conclusions:We found from our localization experiments in the swine lung that, among the commonly used three localization methods, semi-rigid hook wire showed the best operability and practicability than doublethorn hook wire and microcoil. Preoperative localization of small pulmonary nodules with single semi-rigid hook wire system shows a high success rate, acceptable utility and especially low dislodgement in VATS. IntroductionThe widespread application of low-dose computed tomography (LDCT) has led to a great increase in the identification rate of small pulmonary nodules, especially small ground glass opacities (GGO). GGO is defined as a hazy opacity that does not obscure underlying bronchial structures or pulmonary vessels on CT scans (1). It has been reported that 33-60% GGO was malignant carcinoma when the nodules size ranges from 11-20 mm, while the malignant rate increase to 64-82% when the size grows up greater than 20 mm (2). Although the identification of pulmonary nodules could be effectively accomplished by many imaging modalities, including high-resolution CT, positron emission tomography (PET/CT), and bronchoscopy, whereas the identification of lesions with GGO remains difficult. Thus, more reliable diagnosis and therapeutic options for uncertain pulmonary nodules are still in need (3).Video-assisted thoracoscopic surgery (VATS) is less invasive in diagnosing and treating thoracic lesions, thus how to locate and mark the nodules more precisely before the VATS becomes one of the most important ...

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CT-guided percutaneous fine-needle aspiration biopsy of pulmonary nodules measuring 10 mm or less

Cited by 89 publications

References 20 publications

Percutaneous core needle biopsy for small lung nodules with diameters ≤ 10 mm: accurate diagnosis and complication rates

Percutaneous core needle biopsy for small lung nodules with diameters ≤ 10 mm: accurate diagnosis and complication rates

CT-guided transthoracic core needle biopsy for small pulmonary lesions: diagnostic performance and adequacy for molecular testing

Semi-rigid single hook localization the best method for localizing ground glass opacities during video-assisted thoracoscopic surgery: re-aerated swine lung experimental and primary clinical results

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