Abstract
Purpose:To evaluate and compare the diagnostic accuracy of fine needle aspiration (FNA) and core needle biopsy (CNB) of intrathoracic lesions using the same coaxial guide-needle under a C-arm Cone-Beam computed tomography system.Materials and Methods:Two hundred and eighty-eight patients (181 male, 107 female; 65.8 ± 13.3 years) with 293 lesions underwent 300 procedures, in which both FNA and CNB were performed. After inserting the coaxial guide-needle into the target lesion, we performed 18-gauge CNB, followed by 20-gauge FNA through the same coaxial guide-needle. The comparison of the procedures in which both showed adequate sample was performed with McNemar’s test (n = 229).Results:Of 300 procedures, 293 were technically successful. Adequate samples were obtained in 248/300 FNA and 288/300 CNB cases. The sensitivity and specificity for diagnosis of malignancy were respectively 84.7% (133/157), 100% (72/72) for FNA, when atypical cells included benign entity; 97.5% (153/157), 100% (72/72) for FNA, when atypical cells included malignancy; 97.6% (162/166), 100% (102/102) for CNB; and 100% (166/166), 100% (102/102) for combined FNA and CNB. Diagnosis of malignancy was significantly higher for CNB than for FNA (p < 0.001); however, it was not significantly higher when atypical cells included malignancy for FNA. Pneumothorax occurred in 50 (16.7%) and hemoptysis in 18 (6.0%) procedures.Conclusions:Combined use of CNB and FNA using the same coaxial guide-needle showed better diagnostic performance than using one alone. When comparing CNB and FNA, CNB showed significantly better performance, when atypical cells included a benign entity in FNA.
Highlights
The image-guided percutaneous biopsy is a well-established diagnostic option for peripheral lung lesions [1]
In this study, using the same coaxial guide-needle under cone-beam Computed tomography (CT) system (CBCT) guidance, we evaluated the diagnostic performance of the combined fine needle aspiration (FNA) and core needle biopsy (CNB) in the diagnosis of intrathoracic lesions
The overall sensitivity, specificity, and accuracy were respectively 84.7% (133/157), 100% (72/72), and 89.5% (205/229) for FNA, when atypical cells were classified as benign; 97.5% (153/157), 100% (72/72), and 98.3% (225/229) for FNA, when atypical cells were classified as malignant; 97.6% (162/166), 100% (102/102), and 98.5% (264/268) for CNB; and 100% (166/166), 100% (102/102), and 100% (268/268) for combined FNA and CNB (Table 2, Figure 2)
Summary
The image-guided percutaneous biopsy is a well-established diagnostic option for peripheral lung lesions [1]. While there have been comparisons of FNA and CNB for diagnosing lung cancer, a comprehensive analysis of those studies is difficult, because the study designs are different [2, 3]. The studies use different image-guidance methods, usually CT or CT-fluoroscopy. Several studies compare two procedures performed on the same nodule in one visit [4,5,6,7,8,9], while others compare the groups in which one of the biopsy methods is used [10,11,12,13]. The needle gauges used are not uniform, and coaxial guide-
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