Propensity-score-matching analysis to compare efficacy and safety between 16-gauge and 18-gauge needle in ultrasound-guided biopsy for peripheral pulmonary lesions

Abstract

Background Definitive diagnosis of peripheral pulmonary lesions (PPLs) depends on the histological analysis of the pleural biopsy sample. Ultrasound (US)-guided sampling is now standard practice in the clinical setting. However, determining a suitable needle size and sampling times to improve the efficacy and safety of the biopsy remains challenging. Here, we compared the efficacy between 16- and 18-gauge core biopsy needles in US-guided percutaneous transthoracic biopsy for PPLs on histological diagnosis and procedure-related complications. Materials and methods In total, 1169 patients (767 men, 402 women; mean age, 59.4 ± 13.2 years) who received biopsy for PPLs between September 2011 and February 2019 were included. The propensity score matching (PSM) analysis was performed to adjust the baseline differences, and the rate of successful specimen assessment and complications were compared between the 16-gauge (249 patients) and 18-gauge (920 patients) groups. The number of pleural surfaces crossed (NOPSC) was defined as the number of times the visceral pleural surface was transgressed. Stratified analysis was performed based on NOPSC. Results The overall success rate was 92.0% (1076/1169). The overall complication rate was 9.6%, including pneumothorax, hemorrhage, and vasovagal reaction, which occurred in 2.5% (29/1169), 6.6% (77/1169), and 0.5% (6/1169) of the patients, respectively. When NOPSC was 1 or > 2, the success and complication rates in the 16-gauge group were comparable to those of the 18-gauge group (all P > 0.05). When the NOPSC was 2, the success rate in the 16-gauge group was significantly higher than that in the 18-gauge group (P = 0.017), whereas the complication rate was comparable (P > 0.05). Conclusion Higher success rate could be achieved using a 16-gauge than an 18-gauge core biopsy needle in the US-guided percutaneous transthoracic biopsy for PPLs when the NOPSC was 2. We recommend using 16-gauge needles with 2 times of needle passes in biopsy for PPLs in clinical practice.

Ultrasound-guided percutaneous biopsy of peripheral pulmonary lesions with 16-G core needles: study of factors that influence sample adequacy and safety

“…Previous experience demonstrated that a 16-G needle provided a higher success rate during biopsy for PPLs compared with an 18-G needle. 14 As effective lesion sampling is paramount, identifying the factors that influence sample adequacy and safety is an important consideration for radiologists who perform thoracic interventions with 16-G needles. The present results showed that lesion size was an independent factor that influence sample adequacy, while patient position was an independent factor that influence overall complication and post-procedural haemorrhage.…”

“…A 16-G needle could achieve a larger volume of tissue compared with a smaller size needle that is utilised routinely in clinical application at present. 14 It seems that a 16-G needle is capable of achieving sample adequacy for successful diagnosis regardless of number of needle passes.…”

“…Despite recognised advantages and successes with US-guided biopsy for PPLs, previous experience suggested that a 16-G needle with two needle passes could achieve higher success rate compared with an 18-G needle. 14 Most previous studies included cases frequently performed with 18-G core needles and did not systematically provide detailed analysis on 16-G needles due to limited sample size. To find out the factors that influence sample adequacy and safety would provide critical information to improve the efficacy and lower the rate of complication when utilising 16-G needles in biopsy procedures.…”

Ultrasound versus computed tomography-guided transthoracic biopsy for pleural and peripheral lung lesions: a systematic review and meta-analysis

“…Other factors affecting diagnostic yield include needle size and needle type. Huang et al (24) have noted better success rates with a 16-gauge needle compared to 18-gauge needles for USG-guided peripheral lung biopsies. On the other hand, Cheung et al (25) noted no difference in sample adequacy with different needle sizes in the case of CT-guided lung biopsies.…”