CT-guided transthoracic needle biopsy of pulmonary nodules smaller than 20 mm: results with an automated 20-gauge coaxial cutting needle.

AIMS To evaluate the efficacy and the complication rate of CT-guided percutaneous lung biopsy of pulmonary nodules smaller than 20 mm in diameter using a 20-gauge coaxial automated biopsy device. MATERIAL AND METHODS A prospective study was undertaken of 200 patients who underwent 202 consecutive biopsies of pulmonary nodules, performed with a single type of automated biopsy device. Sixty-seven biopsies of nodules smaller than 20 mm in diameter were performed in 66 patients (group A). One hundred and thirty-five biopsies of lesions of 20 mm or greater in size were performed in 134 patients (group B). Patient characteristics, lesion and procedure variables, the accuracy and complication rates were compared. RESULTS In group A, the final diagnosis of the nodules was malignant in 47 and benign in 19 cases (prevalence of malignancy 71. 2%). In group B, there were 111 malignant and 21 benign diagnoses (prevalence of malignancy 82.2%). In group A, the sensitivity and specificity for a diagnosis of malignancy were 89.5 and 100%, respectively (positive predictive value 100%, negative predictive value 76%). A specific diagnosis of benignity was obtained in nine out of 19 (47%) biopsies. The pneumothorax rate was 15% (10 patients) of which two (3%) required drainage. CT signs thought to reflect alveolar haemorrhage were noted in 28 (43%) and haemoptysis occurred in five patients (5.9%). In group B, the sensitivity and specificity for a diagnosis of malignancy were 95.5% and 100%, respectively (positive predictive value 100%, negative predictive value 82.7%). A specific diagnosis of benignity was made in 14 cases (58.3%). Complications included pneumothoraces in 22 cases (16.2%) requiring drainage in one (0.7%). Presumed alveolar haemorrhage was recorded in 19 cases (14.1%) and haemoptysis occurred in seven (5. 2%). There were no significant differences between group A and group B, except for alveolar haemorrhage (P < 0.001). CONCLUSION The accuracy and complication rate of percutaneous CT-guided biopsy of nodules smaller than 20 mm, performed using an automated 20-gauge coaxial biopsy device, are comparable to those for larger lesions.

[1]  V Chechani,et al.  Bronchoscopic diagnosis of solitary pulmonary nodules and lung masses in the absence of endobronchial abnormality. , 1996, Chest.

[2]  W. E. Miller,et al.  Transthoracic needle biopsy: accuracy and complications in relation to location and type of lesion. , 1980, Mayo Clinic proceedings.

[3]  P. T. Moore,et al.  Coaxial percutaneous biopsy technique with automated biopsy devices: value in improving accuracy and negative predictive value. , 1993, Radiology.

[4]  S. Hauptmann,et al.  Cytologic versus histologic evaluation of needle biopsy of the lung, hilum and mediastinum. Sensitivity, specificity and typing accuracy. , 1995, Acta cytologica.

[5]  F. Burbank,et al.  Image-guided automated core biopsies of the breast, chest, abdomen, and pelvis. , 1994, Radiology.

[6]  L R Kaiser,et al.  Video-assisted thoracic surgery: the current state of the art. , 1995, AJR. American journal of roentgenology.

[7]  J. Westcott,et al.  Percutaneous transthoracic needle biopsy. , 1988, Radiology.

[8]  L. Haramati,et al.  CT-guided automated needle biopsy of the chest. , 1995, AJR. American journal of roentgenology.

[9]  M. Hsieh,et al.  Video-assisted thoracic surgery. The Chang Gung experience. , 1994, The Journal of thoracic and cardiovascular surgery.

[10]  P. Friedman,et al.  Difficult thoracic lesions: CT-guided biopsy experience in 150 cases. , 1988, Radiology.

[11]  T. McLoud,et al.  Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules. , 1996, AJR. American journal of roentgenology.

[12]  Y. Nakajima,et al.  CT-guided transthoracic needle biopsy: a comparison between automated biopsy gun and fine needle aspiration. , 1996, Clinical radiology.

[13]  T. McLoud,et al.  Routine addition of an automated biopsy device to fine-needle aspiration of the lung: a prospective assessment. , 1997, AJR. American journal of roentgenology.

[14]  G. Salomon,et al.  Transthoracic needle biopsy with a coaxially placed 20-gauge automated cutting needle: results in 122 patients. , 1996, Radiology.

[15]  O Lucidarme,et al.  Intrapulmonary lesions: percutaneous automated biopsy with a detachable, 18-gauge, coaxial cutting needle. , 1998, Radiology.

[16]  J. Westcott,et al.  Transthoracic needle biopsy of small pulmonary nodules. , 1997, Radiology.

[17]  R. Greene,et al.  Supplementary tissue-core histology from fine-needle transthoracic aspiration biopsy. , 1985, AJR. American journal of roentgenology.

[18]  E. Russi,et al.  Small bronchogenic carcinomas presenting as solitary pulmonary nodules. Bioptic approach guided by CT-positive bronchus sign. , 1992, Chest.

[19]  U. Tylén,et al.  Fine-needle biopsy of chest lesions. , 1982, Der Radiologe.

[20]  K. Thomson,et al.  Evaluation of a new transthoracic needle for biopsy of benign and malignant lung lesions. , 1977, AJR. American journal of roentgenology.

[21]  N. Hayashi,et al.  CT-guided biopsy of pulmonary nodules less than 3 cm: usefulness of the spring-operated core biopsy needle and frozen-section pathologic diagnosis. , 1998, AJR. American journal of roentgenology.

[22]  M. Mack,et al.  Thoracoscopy for the diagnosis of the indeterminate solitary pulmonary nodule. , 1993, The Annals of thoracic surgery.

[23]  W. Sinner,et al.  Pulmonary neoplasms diagnosed with transthoracic needle biopsy , 1979, Cancer.

[24]  M. Mack,et al.  Diagnosing the indeterminate pulmonary nodule: percutaneous biopsy versus thoracoscopy. , 1995, Surgery.

[25]  R. Dowling,et al.  The role of thoracoscopy in the management of intrathoracic neoplastic processes. , 1993, Seminars in thoracic and cardiovascular surgery.

[26]  T. McLoud.  Should cutting needles replace needle aspiration of lung lesions? , 1998, Radiology.