Diagnostic Yield of Computed Tomography-Guided Transthoracic Lung Biopsy in Diffuse Lung Diseases

Abstract

Background: Accurate diagnosis is essential for successful management of diffuse lung disease (DLD). Histopathology may sometimes be necessary. Surgical lung biopsy, the gold standard, carries a risk of morbidity and mortality. Computed tomography (CT) guided transthoracic lung biopsy (CT-TLB) is a minimally invasive method for obtaining lung tissue. However, its diagnostic yield is unknown in DLD. Objective: To assess the diagnostic yield of CT-TLB in DLD according to the predominant high-resolution CT (HRCT) patterns. Methods: Between January 2009 and December 2016, we enrolled all consecutive adult patients with suspicion of DLD who underwent CT-guided transthoracic lung biopsy during the diagnostic work-up. All biopsies were performed by a senior interventional radiologist using CT fluoroscopy. Results: The study included 169 patients (50.3% men) with a mean (±SD) age of 58.3 ± 14 years. Consolidation was the predominant HRCT pattern. A definitive or probable diagnosis was made in 66.3%. The most frequent diagnosis was organizing pneumonia (36.2%). Diagnostic yield was higher when the predominant HRCT pattern was consolidation or nodular. The most common complication was pneumothorax (17.8%); other complications included mild hemoptysis (7.7%), hemothorax (1.2%), and death (0.59%). No acute exacerbation of the underlying condition was observed. Conclusions: CT-TLB proved to be accurate and safe for the diagnosis of DLD. The overall diagnostic yield of the procedure was 66.3%. Given its low complication rates, CT-TLB can be an option in patients whose respiratory function is seriously impaired and in those with substantial comorbidities, where more invasive procedures cannot be performed for reasons of safety.

The future of surgical lung biopsy: moving from the operating room to the bronchoscopy suite

“…CT-TLB for ILD is described by Padrao et al in a retrospective study from Portugal of 169 patients (20). A definitive or probable diagnosis was made in 66.3% of cases (20).…”

“…A definitive or probable diagnosis was made in 66.3% of cases (20). The most frequent diagnosis was organizing pneumonia in 36.2% of cases (20). The diagnostic yields associated with CT-TLB are based mainly on retrospective series.…”

“…The diagnostic yields associated with CT-TLB are based mainly on retrospective series. The diagnostic yields range from 20% to 66% (20). The major complications were pneumothorax (17.8%), mild hemoptysis (7.7%) and hemothorax (1.2%).…”

Lung Biopsy in Interstitial Lung Diseases: There Is More than One Way to Cook an Egg

“…As previously suggested [25], CT-TLB may be particularly contributive in patients presenting with a consolidation pattern and suspicion of organizing pneumonia [26]. It is, in fact, acknowledged by the authors that this technique has been used preferentially over surgery or endoscopic techniques in subjects with consolidation or a nodular pattern, and the series by Padrão et al [20] is therefore not representative of all-comers with ILD.…”

“…In this issue of Respiration, Padrão et al [20] report their experience of percutaneous CT-guided transthoracic lung biopsy (CT-TLB) in patients with ILDs. This technique has been previously used in ILD, but the experience and literature are still limited [21][22][23][24].…”