CT-Guided Transthoracic Biopsy of Pulmonary Lesions: Diagnostic versus Nondiagnostic Results

Abstract

(1) Background: Despite the high accuracy of CT-guided transthoracic biopsy for diagnosis of pulmonary lesions, in a certain amount of cases biopsy results may indicate the presence of nonspecific findings or insufficient material. We aimed to investigate the effectiveness of CT-guided transthoracic biopsy of pulmonary lesions in providing a specific diagnosis and to analyze the variables affecting biopsy results. (2) Methods: In this retrospective study, a total of 170 patients undergoing 183 CT-guided transthoracic biopsies of pulmonary lesions were included. The clinical, radiological and pathological data were reviewed to classify biopsy results as diagnostic or nondiagnostic and to identify which variables were associated with the two groups. (3) Results: The biopsy results were diagnostic in 150 cases (82.0%), of which 131 (87.3%) positive for malignancy and 19 (12.7%) with specific benign lesions, and nondiagnostic in 33 cases (18.0%). Twenty-two of the thirty-three (66.7%) nondiagnostic cases were finally determined as malignancies and eleven (33.3%) as benign lesions. In the diagnostic group, all the 131 biopsies positive for malignancy were confirmed to be malignant at final diagnosis (87.3%); of 19 biopsies with specific benign lesions, 13 cases were confirmed to be benign (8.7%), whereas six cases had a final diagnosis of malignancy (4%). Multivariate analysis showed increased risk of nondiagnostic biopsy for lesions ≤ 20 mm (p = 0.006) and lesions with final diagnosis of benignity (p = 0.001). (4) Conclusions: CT-guided transthoracic lung biopsy is an effective technique for the specific diagnosis of pulmonary lesions, with a relatively acceptable proportion of nondiagnostic cases. Small lesion size and final benign diagnosis are risk factors for nondiagnostic biopsy results.

Computed tomography-guided core needle biopsy for pulmonary nodules: comparison between with and without co-axial technique

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Clinical insights into small cell lung cancer: Tumor heterogeneity, diagnosis, therapy, and future directions

“…When results of the bronchoscopy‐based investigation are nondiagnostic, transthoracic needle biopsy (Figure 5B) can be applied, especially in peripheral lesions 155 . Transthoracic needle biopsy is usually performed using real‐time CT visualization for improved yield and has a sensitivity exceeding 90% 156,157 . In rare cases when none of the previously elaborated methods are successful or feasible, thoracoscopy and surgical biopsy should be considered as the ultimate diagnostic approach 158 .…”

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“…- Otro factor relacionado, es la localización de la masa o nódulo; cuando el nódulo se encuentra en el lóbulo superior o medio, existe una mayor precisión diagnóstica y menor tasa de complicaciones, debido a una mayor facilidad de acceso y por las características anatómicas del pulmón, esto es corroborado por diversos estudios donde las lesiones son menos frecuentes en el lóbulo inferior; siempre se debe calcular el trayecto de la aguja y la vía de acceso a través de la pared torácica (Fig 3), se debe escoger la distancia más corta entre la pared torácica y la periferia del tumor (26,36,37).…”