Inconclusive Result from CT Guided Transthoracic Needle Aspiration and Biopsy: Affecting Factors and Final Outcome

Abstract

Purpose:Inconclusive results from com puted tom ography (CT)-guided transthoracic needle aspiration and biopsy (TNAB) performed for lung lesions presents a clinical dilem m a. The purpose of this study was to determ ine the factors affecting an inconclusive result from a CT guided TNAB, and to evaluate the final outcomes of these inconclusive results. Materials and Methods: The m edical records and radiologic features of 331 patients with lung lesion who received CT guided TNAB were analyzed retrospectively. The results of the TNAB were classified as conclusive (m alignancy or specific benign diagnosis) or inconclusive (nonspecific benign or nondiagnostic). Results: Of the 331 cases, 269 (81.3%) were diagnosed as a malignancy (210) or a specific benign lesion (59) after the first TNAB. The rem aining 62 (18.7% ) were inconclusive. Benign disease, a lesion size ≤15 mm, and morphology of the consolidation type were features significantly correlated with inconclusive results. Of these 62 inconclusive cases a second TNAB was perform ed in 23, and conclusive diagnoses were obtained in 19 (82.6%). Surgery or radiographic follow up was done in other cases. Finally, among the 62 inconclusive results on the first CT guided TNAB, 16 lesions were diagnosed as malignant, 26 were classified as specific benign disease, and the remaining 20 were defined as nonspecific inflam mation. Age over 50 and morphology of a nodule or a mass type were significantly correlated with a malignancy in these 62 cases with inconclusive results on the first TNAB. Conclusion: A final diagnosis of benign disease was significantly higher after the CT guided TNAB was inconclusive for lesions ≤15 mm that had consolidation type m orphology. Despite the application of core biopsy procedures, there continue to be appreciable num bers of inconclusive results after the first CT guided TNAB. A repeat CT guided TNAB had a high diagnostic yield in these cases and therefore should be considered for cases with inconclusive results. (J Lung Cancer 2011;10(2):94 101)

Computed tomography-guided core needle biopsy of lung lesions: Diagnostic yield and correlation between factors and complications

“…Combining the results of the present and relevant previous studies, we recommend that patients with benign CNB diagnoses undergo repeat imaging for ≥2 years to document the stability or resolution of the lesions. If the nodule grows, a repeat biopsy ( 19 – 21 ) or resection ( 22 ) may be required to obtain a definitive diagnosis.…”

Non-diagnostic Results of Percutaneous Transthoracic Needle Biopsy: A Meta-analysis

“…With regard to other pathology findings, the malignancy rate was the highest for specific malignancy (99.8%, 95% CI, 99.7–99.9%; I 2 = 0.00; 11,884 biopsies in 114 studies) 3,4,6–9,11–23,25–68,70,72–76,78,79,81–86,88,90–93,96,99–101,103–105,108,113–115,118–120,124,126–130,132,134,138–147 , followed by atypical cells (91.1%, 95% CI, 87.8–94.5%; I 2 = 0.23; 312 biopsies in 41 studies) 4,9,13,14,17–20,26,27,29,30,34,37,41,42,46,47,53,64,66,70,74–76,79,85,86,89–91,98,101,104,108,115,120,126,129,144,147 , AAH (88.9%, 95% CI, 76.7–100.0%; I 2 = 0.31; 18 biopsies in 6 studies) 8,76,84,126,128,138 , non-specific benign results (20.6%, 95% CI, 17.8–23.4%; I 2 = 0.96; 2574 biopsies in 64 studies) 4,6,8,11,12,19,22,23,26–28,…”

“…The pooled incidence of non-diagnostic results was 6.8% (95% CI, 6.0–7.6%; I 2 = 0.91; 24668 biopsies in 106 studies) 4,6–8,11,12,19,22–24,26–35,38,40–42,44–49,52,54,55,59–62,65–67,69–86,89,91–97,99–103,106–113,115–118,120,122–126,128–133,135–143,146,147 .…”