Abstract
Background: Adequate and representative tissue from lung tumor is important in the era of precision medicine. The aim of this study is to identify detailed procedure-related variables and factors influencing diagnostic success and tissue adequacy for molecular testing in CT-guided TTNB.Methods: Consecutive patients undergoing CT-guided TTNB were retrospectively enrolled between January 2013 and May 2020. Multivariate analysis was performed for predictors for diagnostic accuracy and tissue adequacy for molecular testing. Logistic regression was used to identify risk factors for procedure-related complications.Results: A total of 2,556 patients undergoing CT-guided TTNB were enrolled and overall success rate was 91.5% (2,338/2,556). For lung nodules ≤3 cm, predictors for diagnostic success included coaxial needle use [OR = 0.34 (0.16–0.71), p = 0.004], CT scan slice thickness of 2.5 mm [OR = 0.42 (0.15–0.82), p = 0.011] and additional prefire imaging [OR = 0.31 (0.14–0.68), p = 0.004]. For lung tumor >3 cm, ground glass opacity part more than 50% [OR = 7.53 (2.81–20.23), p < 0.001] or presence of obstructive pneumonitis [OR = 2.31 (1.53–3.48), p < 0.001] had higher risk of diagnostic failure. For tissue adequacy, tissue submitted in two cassettes (98.9 vs. 94.9%, p = 0.027) was a positive predictor; while male (5.7 vs. 2.5%, p = 0.032), younger age (56.61 ± 11.64 vs. 65.82 ± 11.98, p < 0.001), and screening for clinical trial (18.5 vs. 0.7%, p < 0.001) were negative predictors.Conclusions: Using a coaxial needle, with thin CT slice thickness (2.5 mm), and obtaining additional prefire imaging improved diagnostic success, while obtaining more than two tissue cores and submitting in two cassettes improved tissue adequacy for molecular testing.
Highlights
computed tomography (CT)-guided transthoracic needle biopsy (TTNB) is a widely accepted technique to obtain tissue diagnosis from pulmonary lesions
When paraffin-embedded tissue is used for molecular testing of lung cancer, core needle biopsy specimens are more likely than fine needle aspiration (FNA) specimens to provide adequate tissue for molecular testing [7]
The aim of this study is to identify detailed procedure-related variables and factors influencing diagnostic success and tissue adequacy for molecular testing in CT-guided TTNB
Summary
CT-guided transthoracic needle biopsy (TTNB) is a widely accepted technique to obtain tissue diagnosis from pulmonary lesions. In the era of precision medicine, in addition to histopathological diagnosis of tumor subtypes, molecular analysis is mandatory for personalized and targeted cancer treatment [3, 4]. Adequate and representative tissue from the tumor is important for molecular analyses. Prior studies showed that computed tomography-guided percutaneous fine needle aspiration biopsy of lung lesions yielded high success rate in clinically suspicion of primary lung malignancy, superior lobe location, and larger lesion (≥4 cm) [5]. Adequate and representative tissue from lung tumor is important in the era of precision medicine.
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