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

Abstract

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...

Core-needle biopsy under CT fluoroscopy guidance and fine-needle aspiration cytology: Comparison of diagnostic yield in the diagnosis of lung and mediastinum tumors. Analysis of frequency and types of complications

“…The cited literature reports accuracy of 90–100% for lesions over 10 mm, 52–88% for lesions under 10 mm. In our case, the size of the biopsied lesion was no lower than 1 cm, but other authors [14] report high success rate of a CNB with an 18G needle on lesions smaller than 1 cm. Interestingly, authors of the publication did not perform a follow-up CT scan after the biopsy, arguing that although small pneumothorax can be seen on a CT, it is not clinically significant, while those that have clinical significance can be seen on an x-ray performed 2 hours after surgery.…”

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

“…Malignant tumors were defined by: i) Cancer-associated mortality occurring during the follow-up period; ii) lesions representing complete response, partial response or progressive disease to chemotherapy according to the Response Evaluation Criteria in Solid Tumors (4); and iii) a histopathological examination showing malignant tumor tissue in the specimen received at surgical resection. Benign tumors were defined by: i) Lesions that disappeared or decreased in size with conservative treatment; ii) patient exhibited a positive microbiological conclusion (3,5); or iii) a histopathological examination showing no malignant tumor tissue in the specimen from surgical resection. Undetermined tumors were defined as: i) Lesions treated by radiofrequency ablation or stereotactic irradiation (6); ii) a lesion that was stable in size at follow-up; or iii) a patient that could not be contacted for follow-up (Table II).…”

Chinese expert consensus statement on issues related to small specimen sampling of lung cancer

“…In 1976, Haaga carried out transthoracic CNB under CT guidance, which improved the accuracy of the biopsy procedure and resulted in an important technical improvement for the diagnosis of pulmonary disease. [ 43 ] Subsequent clinical studies have further clarified the diagnostic efficiency of lung biopsy and the incidence of complications.…”

“…[ 50 52 ] Results of a study suggest that 100- and 160mm needles are effective for puncture depths <5 cm and >5 cm, respectively. [ 43 ]…”