Abstract
BackgroundComputed tomography (CT)-guided pulmonary core biopsies of small pulmonary nodules less than 15 millimeters (mm) are challenging for radiologists, and their diagnostic accuracy has been shown to be variable in previous studies. Common complications after the procedure include pneumothorax and pulmonary hemorrhage. The present study compared the diagnostic accuracy of small and large lesions using CT-guided core biopsies and identified the risk factors associated with post-procedure complications.MethodsBetween January 1, 2016, and December 31, 2017, 198 CT-guided core biopsies performed on 195 patients at our institution were retrospectively enrolled. The lesions were separated into group A (< or = 15 mm) and group B (> 15 mm) according to the longest diameter of the target lesions on CT. Seventeen-gauge introducer needles and 18-gauge automated biopsy instruments were coaxially used for the biopsy procedures. The accuracy and complications, including pneumothorax and pulmonary hemorrhage, of the procedures of each group were recorded. The risk factors for pneumothorax and pulmonary hemorrhage were determined using univariate analysis of variables.ResultsThe diagnostic accuracies of group A (n = 43) and group B (n = 155) were 83.7 % and 96.8 %, respectively (p = 0.005). The risk factors associated with post-biopsy pneumothorax were longer needle path length from the pleura to the lesion (p = 0.020), lesion location in lower lobes (p = 0.002), and patients with obstructive lung function tests (p = 0.034). The risk factors associated with post-biopsy pulmonary hemorrhage were longer needle path length from the pleura to the lesion (p < 0.001), smaller lesions (p < 0.001), non-pleural contact lesions (p < 0.001), patients without restrictive lung function tests (p = 0.034), and patients in supine positions (p < 0.003).ConclusionCT-guided biopsies of small nodules equal to or less than 15 mm using 17-gauge guiding needles and 18-gauge biopsy guns were accurate and safe. The biopsy results of small lesions were less accurate than those of large lesions, but the results were a reliable reference for clinical decision-making. Understanding the risk factors associated with the complications of CT-guided biopsies is necessary for pre-procedural planning and communication.
Highlights
Computed tomography (CT)-guided pulmonary core biopsies of small pulmonary nodules less than 15 millimeters are challenging for radiologists, and their diagnostic accuracy has been shown to be variable in previous studies
The factors associated with pneumothorax were analyzed in the present study, and the results demonstrated that needle path length from the pleura to target, location of the lesion, and obstructive lung disease were associated with pneumothorax, which is consistent with previous articles [9, 17, 20, 23, 31]
The biopsy results of small lesions were less accurate than the results of large lesions, but the results provided a reliable reference for clinical decision-making
Summary
Computed tomography (CT)-guided pulmonary core biopsies of small pulmonary nodules less than 15 millimeters (mm) are challenging for radiologists, and their diagnostic accuracy has been shown to be variable in previous studies. The present study compared the diagnostic accuracy of small and large lesions using CT-guided core biopsies and identified the risk factors associated with post-procedure complications. Transthoracic CT-guided biopsies are advantageous for peripheral nodules and prevent the sacrifice of normal lung tissue from lobectomy. Previous articles [2, 3] noted some advantages of core biopsies over FNAB, including higher diagnostic accuracy of non-malignant samples, better tissue characterization of carcinoma lesions, and better ability to diagnose carcinoma in the absence of pathologists. Small lesions less than 15 mm remain very challenging for radiologists
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