Abstract
ObjectivesTo meta-analyze complication rate in computed tomography (CT)-guided transthoracic lung biopsy and associated risk factors.MethodsFour databases were searched from 1/2000 to 8/2015 for studies reporting complications in CT-guided lung biopsy. Overall and major complication rates were pooled and compared between core biopsy and fine needle aspiration (FNA) using the random-effects model. Risk factors for complications in core biopsy and FNA were identified in meta-regression analysis.ResultsFor core biopsy, 32 articles (8,133 procedures) were included and for FNA, 17 (4,620 procedures). Pooled overall complication rates for core biopsy and FNA were 38.8 % (95 % CI: 34.3–43.5 %) and 24.0 % (95 % CI: 18.2–30.8 %), respectively. Major complication rates were 5.7 % (95 % CI: 4.4–7.4 %) and 4.4 % (95 % CI: 2.7–7.0 %), respectively. Overall complication rate was higher for core biopsy compared to FNA (p < 0.001). For FNA, larger needle diameter was a risk factor for overall complications, and increased traversed lung parenchyma and smaller lesion size were risk factors for major complications. For core biopsy, no significant risk factors were identified.ConclusionsIn CT-guided lung biopsy, minor complications were common and occurred more often in core biopsy than FNA. Major complication rate was low. For FNA, smaller nodule diameter, larger needle diameter and increased traversed lung parenchyma were risk factors for complications.Key Points• Minor complications are common in CT-guided lung biopsy• Major complication rate is low in CT-guided lung biopsy• CT-guided lung biopsy complications occur more often in core biopsy than FNA• Major complication rate is similar in core biopsy and FNA• Risk factors for FNA are larger needle diameter, smaller lesion size
Highlights
In the US, lung cancer screening by low-dose computed tomography (CT) is recommended for people at high risk [1], Eur Radiol (2017) 27:138–148 and the European Society of Radiology and the European Respiratory Society have recently recommended lung cancer screening within clinical trial setting or in routine clinical practice at certified medical centers [2]
Where some papers report a higher complication rate for core needle biopsy compared to fine needle aspiration (FNA) [5, 6], other studies [7, 8] do not
Yao et al [9] concluded in a systematic review comparing FNA with core biopsy that no significant difference in complication rate between these techniques exists
Summary
In the US, lung cancer screening by low-dose computed tomography (CT) is recommended for people at high risk [1], Eur Radiol (2017) 27:138–148 and the European Society of Radiology and the European Respiratory Society have recently recommended lung cancer screening within clinical trial setting or in routine clinical practice at certified medical centers [2]. This development will cause an increase in CT-detected lung nodules. They concluded that core biopsy is generally reported to have a somewhat higher diagnostic performance compared to FNA, especially in identifying histological subtypes; the evidence is insufficient to support a difference
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