Pulmonary Ground-glass Opacity Lesions Research Articles

The activity and immune dynamics of PD-1 inhibition on high-risk pulmonary ground glass opacity lesions: insights from a single-arm, phase II trial

Immune checkpoint inhibitors targeting the programmed cell death-1 (PD-1) protein significantly improve survival in patients with advanced non-small-cell lung cancer (NSCLC), but its impact on early-stage ground-glass opacity (GGO) lesions remains unclear. This is a single-arm, phase II trial (NCT04026841) using Simon’s optimal two-stage design, of which 4 doses of sintilimab (200 mg per 3 weeks) were administrated in 36 enrolled multiple primary lung cancer (MPLC) patients with persistent high-risk (Lung-RADS category 4 or had progressed within 6 months) GGOs. The primary endpoint was objective response rate (ORR). T/B/NK-cell subpopulations, TCR-seq, cytokines, exosomal RNA, and multiplexed immunohistochemistry (mIHC) were monitored and compared between responders and non-responders. Finally, two intent-to-treat (ITT) lesions (pure-GGO or GGO-predominant) showed responses (ORR: 5.6%, 2/36), and no patients had progressive disease (PD). No grade 3–5 TRAEs occurred. The total response rate considering two ITT lesions and three non-intent-to-treat (NITT) lesions (pure-solid or solid-predominant) was 13.9% (5/36). The proportion of CD8+ T cells, the ratio of CD8+/CD4+, and the TCR clonality value were significantly higher in the peripheral blood of responders before treatment and decreased over time. Correspondingly, the mIHC analysis showed more CD8+ T cells infiltrated in responders. Besides, responders’ cytokine concentrations of EGF and CTLA-4 increased during treatment. The exosomal expression of fatty acid metabolism and oxidative phosphorylation gene signatures were down-regulated among responders. Collectively, PD-1 inhibitor showed certain activity on high-risk pulmonary GGO lesions without safety concerns. Such effects were associated with specific T-cell re-distribution, EGF/CTLA-4 cytokine compensation, and regulation of metabolism pathways.

488P Pulmonary ground glass opacity lesions: Immune ecosystem and its clinical relevances of early-stage lung adenocarcinoma

488P Pulmonary ground glass opacity lesions: Immune ecosystem and its clinical relevances of early-stage lung adenocarcinoma

Acute exacerbation of idiopathic hypereosinophilic syndrome following asymptomatic coronavirus disease 2019: a case report

BackgroundPrevious research has suggested that some autoimmune diseases develop after the occurrence of coronavirus disease 2019. Hypereosinophilic syndrome is a rare disease presenting with idiopathic eosinophilia and multiple organ involvement, including the skin, lungs, gastrointestinal tract, heart, and nervous system. The diagnosis of idiopathic hypereosinophilic syndrome poses a dilemma because clinical manifestation and serum biomarkers are similar to those of eosinophilic granulomatosis with polyangiitis. Only a few cases have been reported where coronavirus disease 2019 may have caused the new onset or exacerbation of eosinophilic granulomatosis with polyangiitis or idiopathic hypereosinophilic syndrome.Case presentationWe present the case of a 48-year-old Japanese woman with history of asthma who developed deteriorating symptoms of insidiously developed idiopathic hypereosinophilic syndrome following asymptomatic coronavirus disease 2019. She developed acute-onset back pain, tachycardia, abdominal discomfort, loss of appetite, weight loss, skin rash on the back, and numbness of the extremities 3 days after the quarantine period. Extreme hypereosinophilia with multiple abnormal findings including pulmonary ground-glass opacity lesions and mononeuritis multiplex was consistent with hypereosinophilic syndrome. Normal cellularity with eosinophilic proliferation in the bone marrow and negative FIP1L1–PDGFRA raised the diagnosis of idiopathic hypereosinophilic syndrome. Although the patient tested negative for anti-neutrophilic cytoplasmic antibodies and skin biopsy was negative for vasculitis, eosinophilic granulomatosis with polyangiitis could not be excluded. Since glucocorticoids are a standard therapy for both idiopathic hypereosinophilic syndrome and eosinophilic granulomatosis with polyangiitis, we initiated glucocorticoids following a multidisciplinary discussion.ConclusionAlthough the relationship between asymptomatic coronavirus disease 2019 and acute idiopathic hypereosinophilic syndrome exacerbation was uncertain, the chronological order of the symptomatic development suggested a possible link. More clinical cases and population-based studies are needed to determine the potential effect of coronavirus disease 2019 on autoimmune diseases.

Small (≤ 20 mm) ground-glass opacity pulmonary lesions: which factors influence the diagnostic accuracy of CT-guided percutaneous core needle biopsy?

BackgroundThe diagnostic accuracy of computed tomography (CT)-guided percutaneous core needle biopsy (CNB) for small (≤ 20 mm) ground-glass opacity (GGO) lesions has not been reported in detail.ObjectivesTo evaluate factors that affect the diagnostic accuracy of CT-guided percutaneous CNB for small (≤ 20 mm) GGO pulmonary lesions.MethodsFrom January 2014 to February 2018, 156 patients with a small (≤ 20 mm) GGO pulmonary lesion who underwent CT-guided CNB were enrolled in this study. Factors affecting diagnostic accuracy were evaluated by analyzing patient and lesion characteristics and technical factors. Significant factors were identified by multivariate logistic regression.ResultsThe diagnostic accuracy of CT-guided percutaneous CNB was 90.4% for small (≤ 20 mm) GGO pulmonary lesions. The diagnostic accuracy was higher for larger lesions (72.5% for lesions ≤ 10 mm, 96.6% for lesions between 11 and 20 mm [P < 0.001]). The diagnostic accuracy of CT-guided percutaneous CNB was 74.5% for lesions with > 90% GGO components and 97.2% for lesions with 50–90% GGO components (P < 0.001). In multivariate analysis, the significant factors influencing diagnostic accuracy were lesion size (P = 0.022; odds ratio [OR] for a lesion between 11 and 20 mm in size was approximately 5 times higher than that for a lesion ≤ 10 mm; 95% confidence interval [CI], 1.3 to 18.5), and GGO component (P = 0.015; OR for a lesion with 50–90% GGO components was approximately 6 times higher than that for a lesion with > 90% GGO components; 95% CI: 1.4 to 25.7).ConclusionsLesion size and GGO component are factors affecting diagnostic accuracy. The diagnostic accuracy was higher for larger lesions and lesions with 50–90% GGO components.

A pilot study of the ultrathin cryoprobe in the diagnosis of peripheral pulmonary ground-glass opacity lesions

BackgroundIt is very difficult to obtain samples of peripheral pulmonary ground-glass opacity lesions (GGOs) by traditional transbronchial biopsy. This study was conducted to evaluate the diagnostic efficacy and safety of transbronchial cryobiopsy (TBCB) of GGOs using a newly developed ultrathin cryoprobe with an outer diameter of 1.1 mm.MethodsWe retrospectively analyzed 20 patients with 23 GGOs who underwent TBCB using the ultrathin cryoprobe from October 2018 to November 2019 in the Shanghai Chest Hospital. The TBCB procedure was performed under the guidance of virtual bronchoscopic navigation (VBN), electromagnetic navigation bronchoscopy (ENB), endobronchial ultrasound, and fluoroscopy. We collected the baseline information of participants, reported diagnostic yield and complications, and analyzed factors may have affected the diagnostic yield.ResultsA total of 23 GGOs (12 pure GGOs, 11 mixed GGOs), with an average diameter of 21.58±11.88 mm, underwent TBCB, and the diagnostic yield was 82.61% (19/23). Of the 19 GGOs diagnosed by TBCB, 12 were adenocarcinomas, 5 were inflammation, 1 was occupational interstitial lung disease, and 1 was a pulmonary meningothelial-like nodule. The remaining 4 undiagnosed lesions were confirmed to be adenocarcinomas by further analysis. The diagnostic yield was unchanged by factors including size (GGOs ≥20 mm, GGOs <20 mm), navigation (VBN, ENB), fluoroscopic visibility (visible, invisible), GGO-component (pure GGOs, mixed GGOs), and guide sheath (K-201, K203). There was no presentation of pneumothorax or severe hemorrhage.ConclusionsThe ultrathin cryoprobe is feasible, safe, and has a high diagnostic yield in the diagnosis of pulmonary GGOs. There is vast potential for the ultrathin cryoprobe as a tool for the diagnosis of GGOs, especially for cases suspicious of early-stage lung cancer.Trial registrationClinicalTrials.gov. No: NCT03716284. Registered: 20 October, 2018. URL: ClinicalTrials.gov.

Quantitative feature analysis of CT images of transbronchial dye markings mimicking true pulmonary ground-glass opacity lesions.

Transbronchial dye marking is a preoperative localization technique aiding pulmonary resection. Post-marking computed tomography (CT) is performed to confirm the locations of the actual markings. This study aimed to evaluate the CT images of dye markings that present as ground-glass opacities (GGO), using quantitative feature analysis. Thin-slice (1 mm) CT images of the dye markings and true ground glass nodule (GGN) lesions were obtained for quantitative analysis with gray-level co-occurrence matrix (GLCM) features. The quantification features including correlation, auto correlation, contrast, energy, entropy, and homogeneity were evaluated. Statistical analysis with boxplot was performed. GLCM features of multi-detector computed tomography (MDCT) images of the dye markings (n=13) and true GGN lesions (n=13) differed significantly in contrast, energy, entropy, auto correlation, and homogeneity. Cone beam computed tomographic (CBCT) image features of another group of dye markings (n=15) also showed a different distribution of feature values, than those of the MDCT images. Quantitative analysis of the dye marking images revealed a discriminative variance, compared with those of the true GGN lesions. Furthermore, the image textures of dye markings on MDCT and CBCT also presented with obvious discrepancies.

EBUS for Solid and Ground Glass Opacity Pulmonary Lesions

In the past several years, X-ray fluoroscopy had been commonly employed to determine the lung field during transbronchial biopsy (TBB); however, precise localization of a PPL has not always been possible leading to low diagnostic yield. For ground glass opacities (GGOs), the value of X-ray fluoroscopy even becomes less. We have previously reported the use of tomosynthesis instead for GGOs. The value of virtual X-ray fluoroscopy and CT fluoroscopy has potential but remains to be known. The advent of endobronchial ultrasound (EBUS) has dramatically increased precise bronchoscopic confirmation of the location of a PPL before sampling. In particular, the radial probe EBUS is used to indicate that a lesion has been reached. For solid peripheral pulmonary lesions (PPLs), Kurimoto et al have described three major types of echogenicities that might differentiate between benignity and malignancy. For GGOs, we have observed constant radial-EBUS patterns that we called blizzard and mixed blizzard signs.

Computed tomography fluoroscopy guided percutaneous lung biopsy for ground-glass opacity pulmonary lesions: A meta-analysis

Computed tomography fluoroscopy guided percutaneous lung biopsy for ground-glass opacity pulmonary lesions: A meta-analysis

A Modified Model for Preoperatively Predicting Malignancy of Solitary Pulmonary Nodules: An Asia Cohort Study

With the recent widespread use of computed tomography, interest in ground glass opacity pulmonary lesions has increased. We aimed to develop a model for predicting the probability of malignancy in solitary pulmonary nodules. We assessed 846 patients with newly discovered solitary pulmonary nodules referred to Fujian Medical University Union Hospital. Data on 18 clinical and 13 radiologic variables were collected. Two thirds of the patients were randomly selected to derive the prediction model (derivation set); the remaining one third provided a validation set. The lesions were divided according to proportion of ground glass opacity (less than 50% or 50% or greater). Univariate analysis of significant covariates for their relationship to the presence of malignancy was performed. An equation expressing the probability of malignancy was derived from these findings and tested on data from the validation group. Receiver-operating characteristic curves were constructed using the prediction model and the Mayo Clinic model. In lesions with less than 50% ground glass opacity, three clinical characteristics (age, presence of symptoms, total protein) and three radiologic characteristics (diameter, lobulation, calcified nodes) were independent predictors of malignancy. In lesions with 50% or more ground glass opacity, two clinical characteristics (sex, percent of forced expiratory volume in 1 second accounting for expected value) and two radiologic characteristics (diameter, calcified nodes) were independent predictors of malignancy. Our prediction model was better than the Mayo Clinic model to distinguish between benign and malignant solitary pulmonary nodules (p < 0.05). Our prediction model could accurately identify malignancy in patients with solitary pulmonary nodules, especially in lesions with 50% or more ground glass opacity.

Radial endobronchial ultrasound images for ground-glass opacity pulmonary lesions.

Radial endobronchial ultrasound (R-EBUS) is a useful tool for precise localisation of peripheral pulmonary lesions, but there have been no detailed reports about the use of R-EBUS images for ground-glass opacity (GGO). The R-EBUS images of 116 patients with GGO, who were diagnosed as having adenocarcinoma by R-EBUS with a guide sheath (EBUS-GS), were compared with the respective chest computed tomography findings. In 103 patients, R-EBUS images were correlated with the histological surgical specimens. R-EBUS images of GGO were identified based on the internal structure of the lesion and classified into two groups. Blizzard showed an enlarged, diffuse hyperintense acoustic shadow. Mixed blizzard showed a combination of blizzard and some diffuse heterogeneity with several hyperechoic dots and vessels. All pure GGO lesions (nine out of nine) were blizzard on R-EBUS. For part-solid GGOs, the percentage of mixed blizzard was inversely related to the amount of the GGO component. Histological findings from surgery revealed that all blizzard lesions were on the spectrum of adenocarcinoma in situ to well differentiated adenocarcinoma while majority (33 out of 64) of mixed blizzard lesions were moderately to poorly differentiated adenocarcinoma. R-EBUS types are important to locate GGOs prior to transbronchial sampling with EBUS-GS.

Meta-analysis of CT-guided transthoracic needle biopsy for the evaluation of the ground-glass opacity pulmonary lesions.

This meta-analysis is to determine the overall diagnostic yield of CT-guided transthoracic needle biopsy (TNB) of ground-glass opacity (GGO) lesions. A PubMed search was performed using "ground-glass opacity" crossed with "core biopsy" and "needle biopsy". Test performance characteristics with the use of forest plots, summary receiver operating characteristic curves and bivariate random effects models were summarized. Adverse events, if reported, were recorded. Our search identified 52 citations, of which 6 diagnostic studies evaluated 341 patients. Pooled specificity estimates were 0.94 [95% confidence interval (CI), 0.84-0.98] and sensitivity estimates were 0.92 (95% CI, 0.88-0.95), respectively. The positive likelihood ratio was 11.27 (95% CI, 4.2-30.6), the negative likelihood ratio was 0.1 (95% CI, 0.06-0.19), the diagnostic odds ratio was 131.38 (95% CI, 39.6-436.0) and the area under the curve was 0.97. Our data suggest that the CT-guided TNB is likely to be a useful tool for tissue diagnosis and may serve as an alternative for further patient management with GGO lesions. However, considering the limited studies and patients included, large scale studies are needed to verify these findings. Some studies about CT-guided TNB of GGO lesions have been published, most have been small, single-institution case series. To our knowledge, our study is the first systematic analysis about CT-guided TNB of GGO lesions.

The diagnostic utility of endobronchial ultrasonography with a guide sheath and tomosynthesis images for ground glass opacity pulmonary lesions.

With the widespread use of computed tomography (CT), the frequency of discovering ground glass opacity (GGO) pulmonary lesions has increased. There have been some reports on surgery or transthoracic needle aspiration (TTNA) for diagnostic sampling of GGOs but none on transbronchial biopsy (TBB). The purpose of this study was to evaluate the diagnostic utility of chest tomosynthesis images and TBB through endobronchial ultrasonography with a guide sheath (EBUS-GS) for GGO. This study included 40 patients (19 men, 21 women; age 66.9±8.7 years, mean ± standard deviation, SD). The mean lesion diameter was 22±10 mm (mean ± SD). Chest tomosynthesis images served as maps prior to bronchoscopic sampling using radial EBUS probe with a guide sheath kit. The overall diagnostic yield of EBUS-GS-guided TBB was 65.0% (26 of 40 lesions). In a multivariate analysis, diagnostic yield of lesions with EBUS images (79.2%, 19 of 24 cases) was significantly higher than those lesions without EBUS images detected (43.8%, 7 of 16 cases) (P=0.017). Detectability on chest tomosynthesis was not a significant contributing factor. Only one complication was observed: pneumothorax that did not require chest tube drainage. TBB through EBUS-GS can be considered as one of the diagnostic methods for GGO. Further technological development is required to identify the location of the target GGO lesion more precisely.

Analysis of tumor markers in cytological fluid obtained from computed tomography–guided needle aspiration biopsies for the diagnosis of ground‐glass opacity pulmonary lesions

The purpose of this study was to assess whether analyses of tumor markers in cytological fluid can improve the performance of computed tomography (CT)-guided needle aspiration biopsy (NAB) for the diagnosis of ground-glass opacity (GGO) pulmonary lesions. Forty-two patients were prospectively enrolled for CT-guided NAB. Levels of cytokeratin 19 fragments (CYFRA 21-1) and carcinoembryonic antigen (CEA) from serum and cytological fluid were measured. The cutoff values of 3.3 ng/mL for CYFRA 21-1 and 5.0 ng/mL for CEA (threshold A) or thresholds by adding 2 standard deviations to the mean levels of markers found in patients without malignancy (threshold B) were used to identify malignancy. The sensitivity and area under the curve (AUC) of NAB alone were compared with those of NAB combined with serum or cytological tumor markers. Among the 42 patients, 30 (71.4%) had malignant and 12 (28.6%) had benign lesions. For NAB alone, the sensitivity, specificity, and AUC for diagnosing GGO were 70.0%, 100%, and 0.850, respectively. The sensitivity and AUC increased significantly for NAB with cytological CYFRA 21-1 compared with NAB alone, using both thresholds (threshold A: 86.7%, P=.026 and .933, P=.016; threshold B: 93.3%, P=.008 and .925, P=.046). Cytological fluid measurements of CYFRA 21-1 can improve the diagnostic performance of CT-guided NAB for GGO pulmonary lesions.

Long-Term Outcomes of 50 Cases of Limited-Resection Trial for Pulmonary Ground-Glass Opacity Nodules

From 1998 to 2002, we performed a trial of prospective limited resection for pulmonary ground-glass opacity lesions 2 cm or smaller. This is the second report on the long-term outcome. The enrollment criteria of the trial were as follows: pulmonary peripheral nodule less than 2 cm, diagnosis or suspected diagnosis of clinical T1N0M0 carcinoma with ground-glass opacity and lack of evident pleural indentations or vascular convergence on high-resolution computed tomography. Limited-resection (wedge or segment) specimens were intraoperatively examined by frozen section. If the nodule was confirmed as Noguchi type A or B with a resection margin of greater than 1 cm, the incision was sutured and the patient followed up. The median surveillance period was 10 years. In a total of 50 enrolled participants, there were two Noguchi type A, 23 type B and 15 type C adenocarcinomas; five atypical adenomatous hyperplasias, four fibroses, and one granuloma. Although there were no patients with recurrence within the first 5 years, in four patients who underwent limited-resection pulmonary adenocarcinoma developed more than 5 years after the initial resection, of either cut-end recurrence or metachronous primary disease. Of 26 patients who underwent limited resection, adenocarcinoma developed in four after more than 5 years. These were possibly cut-end recurrences. We concluded that 5 years is not a sufficient period for follow-up, and that limited resection should still be done only in a trial setting, even for small ground-glass opacity lesions.

Diagnostic performance of percutaneous core needle lung biopsy under multi-CT fluoroscopic guidance for ground-glass opacity pulmonary lesions

Objective The diagnostic performance of percutaneous core needle lung biopsy under multi-CT fluoroscopic guidance for ground-glass opacity (GGO) pulmonary lesions was evaluated. Materials and methods Out of 90 patients who underwent CT fluoroscopy-guided core needle biopsy of GGO lesions at our institution, the biopsy results and the final diagnoses were retrospectively compared in 67 patients with available data (one lesion per patient). Diagnostic performance was also compared according to the lesion size (≤10 mm ( n = 8) versus 11–20 mm ( n = 42) versus >20 mm ( n = 17)), the percentage of GGO component (50–90% ( n = 31) versus >90% ( n = 36)), and the length of needle path (≤7 cm ( n = 45) versus >7 cm ( n = 22)). Finally, all 90 cases were reviewed for complications. Results The overall sensitivity, specificity, and accuracy were 97%, 100%, and 97%, respectively. The diagnostic sensitivity and accuracy tended to be lower in smaller lesions (≤10 mm; 86 and 88%, 11–20 mm; 97 and 98%, >20 mm; 100 and 100%, respectively, p > 0.05), and in lesions with lower percentage of GGO component (50–90%; 93 and 94%, >90%; 100 and 100%, respectively, p = 0.21), but statistical significances were not reached. The sensitivity and accuracy were not significantly affected by the length of needle path (≤7 cm; 98 and 98%, >7 cm; 95 and 96%, respectively, p = 1.00). Fourteen patients (16%) developed pneumothoraces, and 13 patients (14%) experienced mild hemoptysis, all of which resolved conservatively. Conclusion The diagnostic performance was satisfactory, and it was considered that the procedure was appropriate for GGO lesions regardless of lesion size, the percentage of GGO component, or the length of needle path. The procedure was also feasible without any major complications.

Diagnostic Accuracy of CT Fluoroscopy–Guided Needle Aspiration Biopsy of Ground-Glass Opacity Pulmonary Lesions

The purpose of this study was to evaluate the diagnostic performance of CT fluoroscopy-guided percutaneous needle aspiration biopsy of ground-glass opacity (GGO) pulmonary lesions. Twenty-eight patients with GGO lesions who underwent CT fluoroscopy-guided needle aspiration biopsy were enrolled in this study. GGO lesions were divided into three groups according to their size: group 1, lesions < or = 10 mm (n = 10); group 2, lesions 11-20 mm (n = 10); and group 3, lesions > 20 mm (n = 8). Sensitivity, specificity, and diagnostic accuracy were calculated on the basis of 28 needle aspiration biopsy results and were compared among the three groups using Fisher's exact test. Diagnostic accuracy was also compared according to length of needle path (< 5 cm vs 5-9 cm vs > 9 cm) and GGO component (50-90% vs > 90%). Each case was reviewed for complications, which included pneumothorax, thoracostomy tube insertion, and hemoptysis. There were 17 (61%) malignant and 11 (39%) benign lesions. Three (10%) biopsy results were nondiagnostic, all of which were confirmed as benign. The sensitivity, specificity, and accuracy of CT fluoroscopy-guided needle aspiration biopsy for diagnosing GGO were 67%, 100%, and 80% in group 1; 71%, 100%, and 80% in group 2; and 75%, 100%, and 88% in group 3. The diagnostic accuracy of CT fluoroscopy-guided needle aspiration biopsy for diagnosing GGO was not significantly different among the three groups (p > 0.05). The diagnostic accuracy was not significantly different according to the length of the needle path (p > 0.05). However, diagnostic accuracy was significantly more accurate in mixed GGO lesions than in pure GGO lesions (p = 0.046). Five patients (18%) developed a pneumothorax, two of whom (7%) required placement of a thoracostomy tube. Mild hemoptysis occurred in three patients (11%). CT fluoroscopy-guided needle aspiration biopsy is a useful diagnostic technique for GGO pulmonary lesions and has an acceptable complication rate, even for small and deeply located lesions. The diagnostic accuracy is influenced by the GGO component.

Diagnostic Accuracy of CT-Guided Core Biopsy of Ground-Glass Opacity Pulmonary Lesions

Diagnostic Accuracy of CT-Guided Core Biopsy of Ground-Glass Opacity Pulmonary Lesions

Diagnostic Accuracy of CT-Guided Core Biopsy of Ground-Glass Opacity Pulmonary Lesions

The purpose of our study was to evaluate the accuracy of CT-guided percutaneous core biopsy of ground-glass opacity (GGO) pulmonary lesions. The study included 50 patients (24 men, 26 women; age range, 43-78 years) who had a GGO pulmonary lesion and underwent CT-guided core biopsy. Diagnostic accuracy was compared between two groups according to lesion size (< 2 cm vs > or = 2 cm) and GGO component (> 90% vs 50-90%). Each case was reviewed for complications, including pneumothorax, thoracostomy tube insertion, and hemoptysis. Malignancy was finally diagnosed in 33 patients, including three who underwent repeated biopsies, with 33 true-positive and three false-negative findings for an overall sensitivity of 92% (33/36). A benign lesion was finally diagnosed in 10 patients with one false-positive result, for a specificity of 90%. Two benign lesions without confirmative diagnosis because of loss of follow-up and five nondiagnostic samples were excluded from the calculations of sensitivity, specificity, and diagnostic accuracy. The overall diagnostic accuracy was 91%, with a positive predictive value of 97% and a negative predictive value of 75%. Sensitivity and accuracy were not significantly different between the two groups of lesion size and GGO components (p = 0.0491). Ten (18%) patients had pneumothorax, with one (2%) requiring placement of a thoracostomy tube. Mild hemoptysis occurred in seven (13%) patients. CT-guided core biopsy of GGO lesions can yield high diagnostic accuracy and acceptable complication rates approaching those of solid lesions.