Coaxial technique-promoted diagnostic accuracy of CT-guided percutaneous cutting needle biopsy for small and deep lung lesions.

Lu Zhang,Mingsheng Zhang,Hong Qiu,Ping Peng,Lei Shi,Zhiping Xiao,Rubens Chojniak

doi:10.1371/journal.pone.0192920

Lu Zhang, Mingsheng Zhang + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0192920

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Abstract

Coaxial technique is extensively applied to facilitate percutaneous lung lesion biopsy. However, the impact of coaxial technique on diagnostic accuracy remains undecided. We reviewed 485 patients who underwent percutaneous CT-guided needle biopsies of lung lesions in our hospital. All of these biopsies were performed using either a cutting needle alone (n = 268) or a cutting needle combined with a coaxial needle (n = 217). The diagnostic accuracy and complications resulting from the two techniques were then compared. The diagnostic accuracies of the two techniques were comparably high, at 98.2% (with coaxial technique) and 95.9% (without coaxial technique), p = 0.24. Subgroup analysis discovered that for patients with lesions measuring < 1.5 cm and needle path length ≥ 4 cm, the coaxial technique achieved a higher diagnostic accuracy (95.5% vs. 72.7%, p = 0.023). The biopsy was well tolerated in all of the patients. Pneumothorax occurred less often in patients who were biopsied with the coaxial technique (19 versus 43, p = 0.024). Thus, the application of the coaxial technique could improve diagnostic accuracy in patients with small and deep lung lesions, and could reduce the risk of pneumothorax. The combined use of cutting needles with coaxial needles is the preferred technique for performing percutaneous CT-guided lung biopsies.

Highlights

Percutaneous Computed Tomography (CT)-guided needle biopsy of lung lesions is a wellestablished and safe technique for the diagnosis of pulmonary nodules[1]
Patients biopsied with cutting needles combined with coaxial needles were assigned into
The coaxial technique facilitated repeated sampling, and enabled the collection of adequate specimens; a higher diagnostic accuracy was achieved. These results indicated that for the purpose of diagnosis, use of the cutting needle alone was adequate for biopsies of most lesions, but the coaxial technique could improve diagnostic accuracy for small and deep lesions

Summary

Introduction

Percutaneous Computed Tomography (CT)-guided needle biopsy of lung lesions is a wellestablished and safe technique for the diagnosis of pulmonary nodules[1]. Fine-needle aspiration has been described as achieving most lung biopsies with a diagnostic specificity of nearly 100% and a sensitivity of over 90% [2, 3]. The diagnostic accuracy of this technique in benign lung lesions was reported to be lower than 70% [3]. Compared with fine-needle aspiration, tissue core biopsy with a cutting needle achieves a better diagnostic accuracy for benign lung lesions and a comparably high diagnostic accuracy for malignant lung lesions[3, 4] without increasing the risk of complications. With fine-needle aspiration, an on-site cytopathologic evaluation is often recommended, but with the cutting needle technique.

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