CT-Guided Thoracic Biopsy: Evaluating Diagnostic Yield and Complications

Abstract

Introduction: This study retrospectively evaluated CT-guided thoracic biopsies for diagnostic yield, accuracy and complications. Materials and Methods: A retrospective analysis of 384 patients (mean age 62.7 years; male/female = 251/133) who underwent 399 CT-guided thoracic biopsies were performed for evaluating diagnostic yield, accuracy and complications. Correlations between patients age, procedure factors (biopsy-needle size, number of passes, lesion-size, lesion-depth and traversed lung-length) and complications such as pneumothorax, haemothorax and haemoptysis were evaluated. A comparison between fine needle aspiration (FNA) group and core ± FNA group for diagnostic yield and complications was also performed. Results: FNA was performed in 349 patients and core ± FNA in 50 patients. The biopsy samples were adequate in 91.9% and the diagnostic accuracy for malignant lesions was 96.8% with 95.7% sensitivity and 100% specificity. Pneumothorax (detected on CT) occurred in 139 cases (34.8%) and only 12 (3.0%) required insertion of an intercostal drain. Mild haemoptysis occurred in 13 patients (3.2%) and small haemothoraces in 2 patients. Pneumothorax occurrence was significantly associated with the traversed lung-length (>3mm), lesion-size (≤33 mm) and lesion-depth (≥60mm) (P <0.05). Haemoptysis occurrence was also significantly associated with traversed lung-length (>3mm) and lesion-size (≤33 mm) (P <0.05). There was no significant difference between diagnostic yield and complication rate between FNA and core ± FNA groups. Conclusion: CT-guided thoracic biopsy is a safe procedure with high diagnostic yield and low risk of significant complications. Traversed lung-length and smaller lesion size are associated with occurrence of pneumothorax and haemoptysis. Key words: Accuracy, Complications, Diagnostic yield, Haemoptysis, Pneumothorax

Robotic‐assisted bronchoscopy versus CT‐guided transthoracic biopsy for diagnosis of pulmonary nodules

“…CTTB had a significantly higher rate of complications compared to RAB (17% vs. 4.4%). The incidence of pneumothorax for CTTB reported in our study is comparable to previously reported complications, ranging from 15% to 52% 6,8,32,33 . The occurrence of pneumothorax post‐RAB in our study was also within ranges from prior publications 24–26 .…”

“…The most common complications were pneumothorax and hemoptysis. Pneumothorax was considered an adverse effect if it led to admission for observation or chest tube insertion 6 . Hemoptysis was classified according to the Nashville Bleeding Scale, and defined as mild if resolved with suctioning, moderate if required intervention such as wedging of the bronchoscope or instillation of cold saline, and severe if more aggressive measures were necessary and procedure was aborted, including selective intubation for advanced ventilatory support, transfusion or resuscitation 19…”

“…We categorized our findings as: (1) malignant or suspicious of malignancy 6 ; (2) benign for definitive nonmalignant process (e.g., infection, granulomas, etc.) and (3) negative for malignancy including non‐specific benign findings (e.g., inflammation), atypical cells, normal bronchial or alveolar tissue 20 .…”

“…The American College of Chest Physicians and National Comprehensive Cancer Network guidelines recommend diagnosis of the primary lesion, staging, genomic alterations analysis and PD‐L1 status using the least invasive modality and ideally, in a single procedure 3,4 . Currently, computed tomography‐guided transthoracic biopsy (CTTB) is the most accurate diagnostic approach, with a reported sensitivity ranging from 82% to 99% 5–7 . However, once a diagnosis is achieved through CTTB, a second procedure is often required for mediastinal staging and assessment of the full disease extension.…”

“…3,4 Currently, computed tomography-guided transthoracic biopsy (CTTB) is the most accurate diagnostic approach, with a reported sensitivity ranging from 82% to 99%. [5][6][7] However, once a diagnosis is achieved through CTTB, a second procedure is often required for mediastinal staging and assessment of the full disease extension. In addition, CTTB is associated with complications such as pneumothorax, hemoptysis and hemothorax.…”