Comparison of CT-Guided Core Needle Biopsy in Pulmonary Ground-Glass and Solid Nodules Based on Propensity Score Matching Analysis

Abstract

Purpose: To compare the diagnostic accuracy and safety of computed tomography (CT)-guided core needle biopsy (CNB) between pulmonary ground-glass and solid nodules using propensity score matching (PSM) method and determine the relevant risk factors. Methods: This was a single-center retrospective cohort study using data from 665 patients who underwent CT-guided CNB of pulmonary nodules in our hospital between May 2019 and May 2021, including 39 ground-glass nodules (GGNs) and 626 solid nodules. We used a 1:4 PSM analysis to compared the diagnostic yields and complications rates of CT-guided CNB between 2 groups. Results: After PSM, 170 cases involved in the comparison (34 GGNs vs 136 solid nodules) were randomly matched (1:4) by patient demographics, clinical history, lesion characteristics, and procedure-related factors. There was no statistically significant difference in the diagnostic yields and complications rates between 2 groups. Significant pneumothorax incidence increase was noted at small lesion size, deep lesion location, and traversing interlobar fissure ( P < .05). Post-biopsy hemorrhage was a protective factor for pneumothorax ( P < .05). The size/proportion of consolidation of GGN did not influence the diagnostic accuracy and complication incidence ( P > .05). Conclusions: The accuracy and safety of CT-guided CNB were comparable for ground-glass and solid nodules and the size/proportion of consolidation of GGN may be not a relevant risk factor. The biopsy should avoid traversing interlobar fissure as far as possible. Smaller lesion size and deeper lesion location may lead to higher pneumothorax rate and post-biopsy hemorrhage may be a protective factor for pneumothorax.

Shape-Sensing Robotic-Assisted Bronchoscopy versus Computed Tomography-Guided Transthoracic Biopsy for the Evaluation of Subsolid Pulmonary Nodules

“…CTTB is routinely performed for diagnosis of pulmonary nodules. For GGN and PSN, diagnostic yield ranges from 80 to 100% [13, 14, 31‒33]. However, when compared to solid nodules, sensitivity for malignancy in SSN has been found to be relatively lower [14, 34].…”

“…A recent study comparing ssRAB to CTTB for peripheral pulmonary nodules found a significantly lower risk of complications for ssRAB (4.4% vs. 17%; p = 0.002) [19]. Furthermore, in CTTB, mild hemorrhage has been described significantly higher when sampling GGN compared to solid nodules [14]. Potential for complications should be assessed when electing one procedure over the other, considering each individual patient’s risks.…”

Safety and efficacy of microwave ablation for lung cancer adjacent to the interlobar fissure

“…Based on a single‐center study of 875 biopsies, Ruud et al 19 concluded that insertion through the interlobar fissure can cause clinically significant post‐biopsy pneumothorax and chest drainage. An et al 26 analyzed 665 lung biopsies based on propensity score matching analysis and concluded that biopsy puncture through the interlobar fissure was a risk factor for pneumothorax and recommended that biopsy should avoid traversing interlobar fissure as far as possible. Elshafee et al 27 found similar results in a retrospective analysis of 311 lung biopsies.…”

MRI-guided microwave ablation and albumin-bound paclitaxel for lung tumors: Initial experience

“…Computed tomography (CT) and ultrasound are the most widely used traditional imaging modalities for ablation guidance. It is widely acknowledged that CT-guided treatment of lung cancer via microwave ablation entails significant limitations, such as inaccurate ablation-needle puncturing and inaccurate assessment of the ablation boundary, which affect its therapeutic efficacy to a certain extent ( Lu et al, 2012 ; An et al, 2022 ). Magnetic resonance imaging (MRI) has limited value for diagnosing and treating lung diseases due to motion artifacts and low signals ( Boiselle et al, 2013 ; Ciet et al, 2015 ).…”