CT-Guided Fine-Needle Aspiration and Core Needle Biopsies of Pulmonary Lesions: A Single-Center Experience With 750 Biopsies in Japan

Takeshita, Jumpei; Masago, Katsuhiro; Kato, Ryoji; Hata, Akito; Kaji, Reiko; Fujita, Shiro; Katakami, Nobuyuki

doi:10.2214/ajr.14.13151

Cited by 101 publications

(122 citation statements)

References 31 publications

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“…The risk for the development of a pneumothorax in our study is comparable with the results of other large patient collectives in which the pneumothorax incidence was slightly above 20 % [1, 17,26]. As in other studies, the rate of pneumothoraces requiring drainage in our collective was 6 % [18,27]. A reduction of this rate seems possible in that the needle is removed quickly and the patient is turned on his/her side [27].…”

supporting

confidence: 89%

Complications in CT-Guided, Semi-Automatic Coaxial Core Biopsy of Potentially Malignant Pulmonary Lesions

Schulze

Seebacher

Enderes

et al. 2015

Fortschr Röntgenstr

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Purpose: Histological verification of pulmonary lesions is important to ensure correct treatment. Computed tomographic (CT) transthoracic core biopsy is a well-established procedure for this. Comparison of available studies is difficult though, as technical and patient characteristics vary. Using a standardized biopsy technique, we evaluated our results for CT-guided coaxial core biopsy in a semi-automatic technique. Materials and Methods: Within 2 years, 664 consecutive transpulmonary biopsies were analyzed retrospectively. All interventions were performed using a 17/18G semi-automatic core biopsy system (4 to 8 specimens). The incidence of complications and technical and patient-dependent risk factors were evaluated. Results: Comparing the histology with the final diagnosis, the sensitivity was 96.3?%, and the specificity was 100?%. 24 procedures were not diagnostic. In all others immunohistological staining was possible. The main complication was pneumothorax (PT, 21.7?%), with chest tube insertion in 6?% of the procedures (n?=?40). Bleeding without therapeutic consequences was seen in 43 patients. There was no patient mortality. The rate of PT with chest tube insertion was 9.6?% in emphysema patients and 2.8?% without emphysema (p?=?0.001). Smokers with emphysema had a 5 times higher risk of developing PT (p?=?0.001). Correlation of tumor size or biopsy angle and the risk of PT was not significant. The risk of developing a PT was associated with an increasing intrapulmonary depth of the lesion (p?=?0.001). Conclusion: CT-guided, semiautomatic coaxial core biopsy of the lung is a safe diagnostic procedure. The rate of major complications is low, and the sensitivity and specificity of the procedure are high. Smokers with emphysema are at a significantly higher risk of developing pneumothorax and should be monitored accordingly. Key points: ??Using an 18G core biopsy system with 6 specimens will allow immunohistological staining with high sensitivity and specificity. ??Smokers with emphysema are at a significantly higher risk of developing a pneumothorax. Citation Format: ??Schulze R, Seebacher G, Enderes B. et?al. Complications in CT-Guided, Semi-Automatic Coaxial Core Biopsy of Potentially Malignant Pulmonary Lesions. Fortschr R?ntgenstr 2015; 187: 697???702

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supporting

confidence: 89%

Complications in CT-Guided, Semi-Automatic Coaxial Core Biopsy of Potentially Malignant Pulmonary Lesions

Schulze

Seebacher

Enderes

et al. 2015

Fortschr Röntgenstr

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“…The lesion to pleura distance was also a significant factor for pneumothorax in this study and in some other studies in the literature (4,8,(21)(22)(23)(24). In the literature, the needle entry angle is either defined as the angle between the pleura and needle axis or the line perpendicular to the pleura at the entry point and needle axis.…”

Section: Discussionsupporting

confidence: 67%

“…To our knowledge, there are only few studies on transthoracic biopsy using FNA and non-coaxial technique in recent literature (11,12). Table 5 summarizes some of the previous studies performed by other investigators (2,4,5,9,10,14,15). In the present study, the diagnostic accuracy was 97.6%, with 97.3% sensitivity and 100% specificity for malignant disease.…”

Section: Discussionsupporting

confidence: 46%

“…The diagnostic accuracy rates of transthoracic biopsies decline as the lesion size gets smaller, particularly for lesions <2 cm (1,2,4,5,18). In previous studies, different thresholds were suggested for diagnostic failure risk.…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies, different thresholds were suggested for diagnostic failure risk. Some authors suggest that lesions <20 mm consitute a risk for diagnostic failure, while others found that lesions >5 cm are likely to have diagnostic failure (1,4,5,18). Hiraki et al (2) suggested that lesions <10 mm and >31 mm could be a risk factor for diagnostic failure.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy of pulmonary lesions with non-coaxial technique: a single center experience with 442 biopsies

Uzun

Akkaya²,

Atman³

et al. 2017

Diagn Interv Radiol

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CT-guided percutaneous transthoracic biopsy of the lung is a well-established method for diagnosis of pulmonary lesions yielding a diagnostic accuracy of 71%-95% (1-5), with pneumothorax being the most common complication varying between 17% and 26% (5-7). Currently coaxial technique is more commonly employed than the non-coaxial technique. The risk of pneumothorax may play a decisive role on this preference. Theoretically, fewer pleural passes means less risk of pneumothorax with the coaxial technique. However, introduction of relatively large bore needles are needed in the coaxial technique, which is a known risk factor for the development pneumothorax (8,9). To the best of our knowledge, there are only a few studies on CT-guided transthoracic fine needle aspiration (FNA) biopsies with non-coaxial technique on large patient populations (10, 11).The purpose of this retrospective study was to evaluate the diagnostic accuracy and safety of CT-guided transthoracic biopsy of pulmonary lesions with FNA using the non-coaxial technique. Methods PatientsThe institutional review board approved this retrospective study protocol and waived informed consent.CT images and biopsy records were retrospectively evaluated in 442 patients (346 males [78.3%] and 96 females [21.7%]; mean age, 64±10.8 years; range, 22-89 years) who underwent CT-guided transthoracic FNA of pulmonary lesions between July 2011 and June 2015. Bronchoscopy or transbronchial biopsies were nondiagnostic or not feasible in these patients.Exclusion criteria for the procedure were lesions <5 mm in maximum diameter, lesions suspected to be of vascular origin, uncorrectable coagulopathy (international normalized ratio ≥1.5, platelet count <50,000 K/UL), patients who were unable to maintain the appro- I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEWe aimed to evaluate the diagnostic accuracy and safety of computed tomography (CT)-guided biopsy of pulmonary lesions with fine needle aspiration (FNA) using non-coaxial technique. METHODSWe analyzed 442 patients who underwent CT-guided lung biopsy with FNA and non-coaxial technique to determine the diagnostic outcomes, complication rates, and independent risk factors for diagnostic failure and pneumothorax. RESULTSDiagnostic accuracy, sensitivity, and specificity were 97.6%, 97.3%, and 100%, respectively. Age and >35 mm lesion size were significant risk factors for diagnostic failure. The rates of pneumothorax and chest tube placement were 19% and 2.9%, respectively. Middle and lower lobe location, lesion to pleura distance >7.5 mm, and >45° needle trajectory angle were significant risk factors for pneumothorax. CONCLUSIONCT-guided FNA of pulmonary lesions with non-coaxial technique is a safe and reliable method with a relatively low pneumothorax rate and an acceptably high diagnostic accuracy.

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Utility of liquid‐based cytology on residual needle rinses collected from core needle biopsy for lung nodule diagnosis

Lan

Zhang

et al. 2021

Cancer Medicine

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CT-Guided Fine-Needle Aspiration and Core Needle Biopsies of Pulmonary Lesions: A Single-Center Experience With 750 Biopsies in Japan

Abstract: CT-guided lung biopsy has a high diagnostic accuracy. Complication rates were acceptable and comparable to those of previous studies.

Cited by 101 publications

References 31 publications

Complications in CT-Guided, Semi-Automatic Coaxial Core Biopsy of Potentially Malignant Pulmonary Lesions

Complications in CT-Guided, Semi-Automatic Coaxial Core Biopsy of Potentially Malignant Pulmonary Lesions

Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy of pulmonary lesions with non-coaxial technique: a single center experience with 442 biopsies

Utility of liquid‐based cytology on residual needle rinses collected from core needle biopsy for lung nodule diagnosis

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