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

Abstract

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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