CT-guided transthoracic core needle biopsy for small pulmonary lesions: diagnostic performance and adequacy for molecular testing

Tian, Panwen; Wang, Ye; Li, Lei; Zhou, Yongzhao; Luo, Wenxin; Li, Weimin

doi:10.21037/jtd.2017.02.16

Cited by 59 publications

(90 citation statements)

References 32 publications

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“…We report the largest single‐institution study examining the performance of TTNB for genotyping of NSCLC patients and confirm that TTNB is a safe and effective method of obtaining sufficient tissue for genomic profiling; 510 (89%) of the 577 biopsies in our cohort sent for genomic testing had sufficient tissue for mutation analysis. This is at the high end of the range of diagnostic yield reported in other smaller series, with reported yields of 67% to 94% for genomic profiling of TTNB specimens . We found no significant difference in diagnostic yield between 18‐ and 20‐G core needle biopsy (CNB), similar to Cheung et al who compared 18‐G vs 20‐G CNB in 47 patients undergoing TTNB for EGFR mutation analysis.…”

Section: Discussionsupporting

confidence: 81%

“…TTNB has been shown to be an effective method of obtaining tissue for NSCLC molecular analysis in NSCLC in a number of small studies with 18 to 172 patients and in one large cohort of 560 patients, using 18 G CNB specimens only . There are no large studies to date reporting the performance and outcomes of different methods of TTNB (FNA, 18‐G CNB, 20‐G CNB) in NSCLC molecular testing.…”

Section: Introductionmentioning

confidence: 99%

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Success of genomic profiling of non–small cell lung cancer biopsies obtained by trans‐thoracic percutaneous needle biopsy

Gill

Murphy

Kravets

et al. 2018

Journal of Surgical Oncology

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Purpose Genomic profiling for personalized targeted therapy has become standard of care. We report the success of genomic profiling of non–small cell lung cancer (NSCLC) obtained by trans‐thoracic needle biopsy (TTNB) in a single center experience. Materials and Methods Patients with NSCLC who underwent TTNB for genomic were identified. Pathology specimens were evaluated for tumor adequacy and then analyzed for selected exons of epidermal growth factor receptor, KRAS, BRAF, PIK3CA, and ERBB2. ALK rearrangements were detected with fluorescence in situ hybridization and/or immunohistochemistry. Technical success was recorded and the factors affecting successful profiling were evaluated. Complications (pneumothorax, hemorrhage, and admission) were recorded. Comparison of yield and complications were done between the two groups (core biopsy and fine needle aspiration only group). Utility of PET‐CT to guide the needle track for optimized yield was assessed in a subset of patients. Results Between December 6, 2009, and December 30, 2016, 765 patients with NSCLC underwent TTNB. Five‐hundred and seventy‐seven of 765 (75%) of all TTNB were profiled, for genomic analysis. Five‐hundred and eight of 577 (88%) were successfully profiled. The number of samples obtained ranged from 1 to 10 (1 to 2 cm, 18 to 20 G). Lesions biopsied ranged in size from 0.6 to 16 cm. No statistically significant difference was observed in the incidence of pneumothorax between two groups (P = 0.26). PET guidance was not found to be statistically significant ( P = 0.79) in the overall yield. Conclusion Computed tomographic guided TTNB is a safe and efficacious technique for genomic profiling, enables the acquisition of sufficient tissue for genetic mutation analyses allowing for personalized therapy with an acceptable complication rate.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Success of genomic profiling of non–small cell lung cancer biopsies obtained by trans‐thoracic percutaneous needle biopsy

Gill

Murphy

Kravets

et al. 2018

Journal of Surgical Oncology

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“…The most common complication was pneumothorax (17.8%), followed by mild hemoptysis (7.7%) and hemothorax (1.2%); these data are in line with other reports on this technique, even though reported complication rates are highly variable [21,25,26,46]. Apart from the patient who died from procedure-related complication, none of the other events that occurred in our study were considered life-threatening for patients undergoing CT-guided transthoracic lung biopsy.…”

Section: Discussionsupporting

confidence: 88%

“…In this context, this technique has widespread acceptance as a preferred method of diagnosis, since it has already been demonstrated to be significantly accurate and safe [20][21][22][23][24]. The diagnostic yield of CT-guided transthoracic lung biopsy in nodules or masses has been reported to be as high as 95% [23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Yield of Computed Tomography-Guided Transthoracic Lung Biopsy in Diffuse Lung Diseases

et al. 2018

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Background: Accurate diagnosis is essential for successful management of diffuse lung disease (DLD). Histopathology may sometimes be necessary. Surgical lung biopsy, the gold standard, carries a risk of morbidity and mortality. Computed tomography (CT) guided transthoracic lung biopsy (CT-TLB) is a minimally invasive method for obtaining lung tissue. However, its diagnostic yield is unknown in DLD. Objective: To assess the diagnostic yield of CT-TLB in DLD according to the predominant high-resolution CT (HRCT) patterns. Methods: Between January 2009 and December 2016, we enrolled all consecutive adult patients with suspicion of DLD who underwent CT-guided transthoracic lung biopsy during the diagnostic work-up. All biopsies were performed by a senior interventional radiologist using CT fluoroscopy. Results: The study included 169 patients (50.3% men) with a mean (±SD) age of 58.3 ± 14 years. Consolidation was the predominant HRCT pattern. A definitive or probable diagnosis was made in 66.3%. The most frequent diagnosis was organizing pneumonia (36.2%). Diagnostic yield was higher when the predominant HRCT pattern was consolidation or nodular. The most common complication was pneumothorax (17.8%); other complications included mild hemoptysis (7.7%), hemothorax (1.2%), and death (0.59%). No acute exacerbation of the underlying condition was observed. Conclusions: CT-TLB proved to be accurate and safe for the diagnosis of DLD. The overall diagnostic yield of the procedure was 66.3%. Given its low complication rates, CT-TLB can be an option in patients whose respiratory function is seriously impaired and in those with substantial comorbidities, where more invasive procedures cannot be performed for reasons of safety.

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“…Computed tomography (CT)-guided needle biopsy was first reported by Haaga in 1976 (1), and with advances in technology, CT has become the primary guidance technique for transthoracic needle biopsies, especially for lesions that other imaging devices cannot visualize (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Potential complications of CT-guided needle biopsy include pneumothorax, hemoptysis, infection, implant transfer, and air embolism (12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Logistic regression analysis and a risk prediction model of pneumothorax after CT-guided needle biopsy

Zhao¹,

Wang²,

Wang³

et al. 2017

J. Thorac. Dis.

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Background: Pneumothorax is the most common complication of computed tomography (CT)-guided needle biopsy. The purpose of this study was to investigate independent risk factors of pneumothorax, other than emphysema, after CT-guided needle biopsy and to establish a risk prediction model. Methods: A total of 864 cases of CT-guided needle biopsy with an 18-gauge cutting needle were enrolled in this study. The relevant risk factors associated with pneumothorax included age, sex, emphysema, shortaxis size of the lesion, depth of the lesion, body position, and the number of pleural punctures. Several independent risk factors of pneumothorax were found, and a predictive model for pneumothorax was established using univariate and multivariate logistic regression analyses. Results: Pneumothorax occurred in 31.4% (271/864) of cases. Univariate analysis showed that significant risk factors of pneumothorax included age, emphysema, small lesion size, no contact between the lesion and the pleura, prone or lateral body position, and multiple punctures. Independent risk factors of pneumothorax in the multivariate logistic regression analysis included emphysema (P=0.000), no contact between the lesion and the pleura (P=0.000), prone or lateral body position (P=0.002), and the number of pleural punctures (P=0.000). The sensitivity, specificity, and accuracy of the predictive model for pneumothorax were 56.8%, 79.6%, and 72.5%, respectively. Conclusions: Pneumothorax is a common complication of CT-guided lung biopsy. Independent risk factors of pneumothorax include emphysema, no contact between the lesion and the pleura, and prone or lateral body position. The predictive model developed in this study was highly accurate in predicting the incidence of pneumothorax.

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CT-guided transthoracic core needle biopsy for small pulmonary lesions: diagnostic performance and adequacy for molecular testing

Cited by 59 publications

References 32 publications

Success of genomic profiling of non–small cell lung cancer biopsies obtained by trans‐thoracic percutaneous needle biopsy

Success of genomic profiling of non–small cell lung cancer biopsies obtained by trans‐thoracic percutaneous needle biopsy

Diagnostic Yield of Computed Tomography-Guided Transthoracic Lung Biopsy in Diffuse Lung Diseases

Logistic regression analysis and a risk prediction model of pneumothorax after CT-guided needle biopsy

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