Abstract
(1) Background: Despite the high accuracy of CT-guided transthoracic biopsy for diagnosis of pulmonary lesions, in a certain amount of cases biopsy results may indicate the presence of nonspecific findings or insufficient material. We aimed to investigate the effectiveness of CT-guided transthoracic biopsy of pulmonary lesions in providing a specific diagnosis and to analyze the variables affecting biopsy results. (2) Methods: In this retrospective study, a total of 170 patients undergoing 183 CT-guided transthoracic biopsies of pulmonary lesions were included. The clinical, radiological and pathological data were reviewed to classify biopsy results as diagnostic or nondiagnostic and to identify which variables were associated with the two groups. (3) Results: The biopsy results were diagnostic in 150 cases (82.0%), of which 131 (87.3%) positive for malignancy and 19 (12.7%) with specific benign lesions, and nondiagnostic in 33 cases (18.0%). Twenty-two of the thirty-three (66.7%) nondiagnostic cases were finally determined as malignancies and eleven (33.3%) as benign lesions. In the diagnostic group, all the 131 biopsies positive for malignancy were confirmed to be malignant at final diagnosis (87.3%); of 19 biopsies with specific benign lesions, 13 cases were confirmed to be benign (8.7%), whereas six cases had a final diagnosis of malignancy (4%). Multivariate analysis showed increased risk of nondiagnostic biopsy for lesions ≤ 20 mm (p = 0.006) and lesions with final diagnosis of benignity (p = 0.001). (4) Conclusions: CT-guided transthoracic lung biopsy is an effective technique for the specific diagnosis of pulmonary lesions, with a relatively acceptable proportion of nondiagnostic cases. Small lesion size and final benign diagnosis are risk factors for nondiagnostic biopsy results.
Highlights
Computerized tomography (CT)-guided transthoracic lung biopsy is a well-established and commonly performed procedure in thoracic interventional radiology for tissue diagnosis of pulmonary lesions
Of the 183 CT-guided lung biopsies included in the dataset, 150 (82.0%) and 33 (18.0%) biopsies showed diagnostic and nondiagnostic results, respectively
In the 22 malignant cases with nondiagnostic biopsy results, the final diagnosis was achieved by repeat CT-guided biopsy in 5 cases (22.7%), surgery in 14 cases (63.6%) and clinical and radiological follow-up in 3 cases (13.7%)
Summary
Computerized tomography (CT)-guided transthoracic lung biopsy is a well-established and commonly performed procedure in thoracic interventional radiology for tissue diagnosis of pulmonary lesions. Since the introduction of specific chemotherapy drugs with different effectiveness based on lung cancer histotype and the approval of targeted and immunotherapeutic agents, lung biopsy has gained great importance in histological and molecular characterization of non-small cell lung cancer (NSCLC) [7,8]. In this contemporary context of personalized therapy, tumor subtyping and molecular analysis have become essential in NSCLC, in order to identify specific tumor characteristics and enable more individualized treatments [9]
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