Computed Tomography–Guided Percutaneous Needle Biopsy of Pulmonary Nodules: Impact of Nodule Size on Diagnostic Accuracy

Kothary, Nishita; Lock, Laura; Sze, Daniel Y.; Hofmann, Lawrence V.

doi:10.3816/clc.2009.n.049

Cited by 125 publications

(86 citation statements)

References 21 publications

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“…Because most of our cases have a large metastases (mean size is above 4 cm) the diagnostic accuracy has been high [12]. Moreover, the preoperative diagnosis of large mass (Figure 1) suspected for LM is of paramount importance as extended operations for LM have been reported with poor outcome [13].…”

Section: Discussionmentioning

confidence: 99%

Current Role of Computed Tomography-Guided Transthoracic Needle Biopsy of Metastatic Lung Lesions

et al. 2015

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Aim: As part of the Catania symposium on lung metastasectomy we reviewed our practice of computed tomography (CT)-guided percutaneous transthoracic needle biopsy of pulmonary metastatic lesions with particular emphasis on diagnostic accuracy and nature of complications lesions. materials & methods: 25 patients with metastatic lesions of the lung have been evaluated between May 2010 and February 2014. Inclusion criteria consisted of patients with histologically confirmed, metastatic disease of the lung, those receiving a CT-guided needle biopsy, were at least 18 years of age; and with adequate hepatic, renal and hematological function. We recorded also the size of the sampled lesions, their distance from the pleura, the complications encountered (pneumothorax and thoracostomy tube placement), the cytological diagnosis and the outcome in all the cases. Results: CT-guided percutaneous transthoracic needle biopsy were performed on 23 of 25 patients with suspected lung metastases. 17 males and six females with a mean age of 71.4 years. The mean size of lesions was 4.2 cm (range: 1 to 17 cm). For CT-guided needle biopsy, an 18 gauge semi-automatic needle biopsy device was used. Of 23 biopsies, 20 (87%) yielded a correct diagnosis with specific histological typing for metastasis. Pneumothorax was the most common complication occurring in four cases (5.7%). Conclusion: CT-guided percutaneous transthoracic needle biopsy is a firm, useful and safe technique for the diagnosis of suspected pulmonary metastases as it avoids open biopsy in most cases. Keywords• CT-guided biopsy • lung metastasis • transthoracic needle biopsy It is known that the lungs are a common site for metastases from other primary cancers, such as breast, colon and sarcomas. Although in the patients with high-risk of lung metastasis the increasing utility of computed tomography (CT) low-dose screening has grown dramatically the sensitivity of identifying small lung nodules [1], CT-guided needle biopsy (CTgNB) of lung metastases (LM) with automatic or semi-automatic biopsy gun have proven to bring in diagnostic label with few complications and is widely accepted as accurate and safe procedure for characterizing pulmonary nodules. [2] Percutaneous transthoracic needle biopsy guided by CT is considered as a relatively well and safe method for diagnosing LM [3]. The rates of diagnostic accuracy have been documented between 72 and 100% for pulmonary metastatic lesions. However, the diagnostic accuracy decrease for smaller lesions between 10 and 20 mm; several studies have reported the diagnostic accuracy range of 52 and 96.5% [4,5].The purpose of our study was to review our experience with CT-guided biopsy of suspected LM with a view to providing a critical assessment of the efficacy and safety of the procedure.For reprint orders, please contact: reprints@futuremedicine.com

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Section: Discussionmentioning

confidence: 99%

Current Role of Computed Tomography-Guided Transthoracic Needle Biopsy of Metastatic Lung Lesions

et al. 2015

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“…In most studies, sensitivity for identifying malignancy was Ն 90%, but it was somewhat lower (70%-82%) in three studies that analyzed results for patients with nodules measuring Յ 15 mm in diameter. 62,86,87 More importantly, a sensitivity of 90% in a high-prevalence population (about 70%) translates to a risk of nondiagnostic results in about 20% of individuals with malignant nodules.…”

Section: Transthoracic Needle Biopsymentioning

confidence: 99%

Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer?

Gould

Donington

Lynch

et al. 2013

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we suggest that no additional diagnostic evaluation need be performed (Grade 2C) .Remark : This recommendation applies only to solid nodules. For guidance about follow-up of subsolid nodules, see Recommendations 6.5.1 to 6.5.4 . 2.3.3.In the individual with an indeterminate nodule that is identifi ed by chest radiography, we recommend that CT of the chest should be performed (preferably with thin sections Objectives: The objective of this article is to update previous evidence-based recommendations for evaluation and management of individuals with solid pulmonary nodules and to generate new recommendations for those with nonsolid nodules. Methods: We updated prior literature reviews, synthesized evidence, and formulated recommendations by using the methods described in the "Methodology for Development of Guidelines for Lung Cancer" in the American College of Chest Physicians Lung Cancer Guidelines, 3rd ed. Results: We formulated recommendations for evaluating solid pulmonary nodules that measure . 8 mm in diameter, solid nodules that measure Յ 8 mm in diameter, and subsolid nodules. The recommendations stress the value of assessing the probability of malignancy, the utility of imaging tests, the need to weigh the benefi ts and harms of different management strategies (nonsurgical biopsy, surgical resection, and surveillance with chest CT imaging), and the importance of eliciting patient preferences. Conclusions: Individuals with pulmonary nodules should be evaluated and managed by estimating the probability of malignancy, performing imaging tests to better characterize the lesions, evaluating the risks associated with various management alternatives, and eliciting their preferences for management. CHEST 2013; 143(5)(Suppl):e93S-e120SAbbreviations: AAH 5 atypical adenomatous hyperplasia; ACCP 5 American College of Chest Physicians; AIS 5 adenocarcinoma in situ; EBUS 5 endobronchial ultrasound; ENB 5 electromagnetic navigation bronchoscopy; FDG 5 fl uorodeoxyglucose; HU 5 Hounsfi eld unit; LR 5 likelihood ratio; SPECT 5 single-photon emission CT; TBB 5 transbronchial biopsy; TTNB 5 transthoracic needle biopsy; VATS 5 video-assisted thoracic surgery; VBN 5 virtual bronchoscopy navigation; VDT 5 volume doubling time

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“…The appropriate use of invasive diagnostic and therapeutic procedures is vitally important but depends greatly on available resources and expertise. As a general rule, transthoracic needle biopsy is an effective approach in experienced hands, but it has important limitations for very small nodules and ground-glass lesions due to potential problems with inadequate sampling and false-negative results (84)(85)(86). Newer guided transbronchial tissue sampling techniques that use electromagnetic navigation and endobronchial ultrasonography-guided nodal sampling have greatly extended the role and accuracy of bronchoscopy for diagnosis and staging (87,88), while minimally invasive surgery with lung-sparing technique enables diagnosis and definitive treatment in selected patients (89)(90)(91)(92).…”

Section: Nodule Locationmentioning

confidence: 99%

Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017

et al. 2017

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The Fleischner Society Guidelines for management of solid nodules were published in 2005, and separate guidelines for subsolid nodules were issued in 2013. Since then, new information has become available; therefore, the guidelines have been revised to reflect current thinking on nodule management. The revised guidelines incorporate several substantive changes that reflect current thinking on the management of small nodules. The minimum threshold size for routine follow-up has been increased, and recommended follow-up intervals are now given as a range rather than as a precise time period to give radiologists, clinicians, and patients greater discretion to accommodate individual risk factors and preferences. The guidelines for solid and subsolid nodules have been combined in one simplified table, and specific recommendations have been included for multiple nodules. These guidelines represent the consensus of the Fleischner Society, and as such, they incorporate the opinions of a multidisciplinary international group of thoracic radiologists, pulmonologists, surgeons, pathologists, and other specialists. Changes from the previous guidelines issued by the Fleischner Society are based on new data and accumulated experience. Table. These are followed by graded ratings of each recommendation using the American College of Chest Physicians recommendations for evidence grading in clinical guidelines (9). Additional explanations are provided regarding the rationale for each recommendation, which is based on the consensus of a multidisciplinary team and a systematic review of the literature, further details of which are included in Appendix E1 [online]. The minimum threshold size for recommending follow-up is based on an estimated cancer risk in a nodule on the order of 1% or greater. This criterion is necessarily arbitrary, and we recognize that a higher threshold may be considered appropriate in some environments and that this threshold will ultimately depend on social and economic factors. Several general considerations regarding technical aspects of using these recommendations are also presented. Finally, in Appendix E1 (online), additional information regarding methods and risk factors is given. detected at CT in adult patients who are at least 35 years old. Separate guidelines have been issued for lung cancer screening, such as those from the American College of Radiology (ACR), and we support the use of those guidelines when interpreting the results of CT screening (8). Specific recommendations are provided for patients with multiple solid and subsolid nodules, and several other commonly encountered clinical situations are addressed.These guidelines are not intended for use in patients with known primary cancers who are at risk for metastases, nor are they intended for use in immunocompromised patients who are at risk for infection; in these patients, treatment should be based on the specific clinical situation. Also, because lung cancer is rare in children and adults younger than 35 years, these guidelines are no...

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Computed Tomography–Guided Percutaneous Needle Biopsy of Pulmonary Nodules: Impact of Nodule Size on Diagnostic Accuracy

Cited by 125 publications

References 21 publications

Current Role of Computed Tomography-Guided Transthoracic Needle Biopsy of Metastatic Lung Lesions

Current Role of Computed Tomography-Guided Transthoracic Needle Biopsy of Metastatic Lung Lesions

Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer?

Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017

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