CT-Guided Core Needle Biopsy of Peripheral Lung Lesions with Onsite Adequate Evaluation: Review of 215 Cases

Abstract

Background: CT-guided core biopsy and fine needle aspiration have been used for diagnosis of peripheral lung lesions, and both methods have advantages and disadvantages. In our institution, CT-guided core needle biopsy with onsite cytology adequacy evaluation of touch preparations is the standard method for evaluation of peripheral lung lesions. Methods: The study was approved by Institutional Review Board. We retrospectively reviewed the cytology reports of all lung core needle biopsies during 2009-2012. The clinical information was collected from chart review. Results: There were total 215 cases during the study period. The average lesion size (in 190 available cases) was 3.46 cm. The average passes were 3.3/lesion. The final diagnoses included 132 malignancies, 70 benign and 13 atypical. Twenty-four cases had follow-up resections. There were two false negative diagnoses due to sample errors and there was no false positive case with a positive predictive value of 100%. The final adequate rate was 99.5% (214/215), and only one case was unsatisfactory. In the 204 patients with available information of post-procedure chest X-ray, 140 (68.6%) had no pneumothorax, and 64 (31.4%) had pneumothorax including 48 mild (23.5%), 3 moderate (1.5%), 2 severe (1%), 3 tension pneumothorax (1.5%), and 8 with chest tubes placed during procedure (3.9%). Conclusions: Our study showed that CT-guided core biopsy with onsite cytology evaluation has high adequate and low atypical rates. Lung core biopsy can provide more accurate tumor classification and specific diagnoses for non-neoplastic lesions. Adequate tissue is often available for molecular study. The complication rate of pneumothorax in core needle biopsy is compatible to that of fine needle aspiration.