Percutaneous transthoracic needle aspiration: a review

Perlmutt, Louis M.; Johnston, William W.; Dunnick, N. Reed

doi:10.2214/ajr.152.3.451

Cited by 140 publications

(82 citation statements)

References 32 publications

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“…PCNB is generally regarded as a safe procedure with limited morbidity and extremely rare mortality (2)(3)(4)(5). Biopsies of pulmonary lesions as small as 3 mm in diameter have been reported (6,7).…”

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confidence: 99%

Percutaneous core needle biopsy for small lung nodules with diameters ≤ 10 mm: accurate diagnosis and complication rates

Jae

June²,

Yie³

et al. 2012

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE To evaluate accurate diagnosis and complication rates of percutaneous core needle biopsy (PCNB) with an automated gun for small lung nodules that are 10 mm or less in diameter. MATERIALS AND METHODSForty-two cases of small lung nodules with diameters ≤10 mm (mean diameter, 9 mm) that received a PCNB were included in this study. Imaging guidance was fluoroscopy in 30 cases and computed tomography (CT) in 12 cases. RESULTSAccurate diagnosis was achieved with the initial PCNB in 88.1% (37/42) of cases. Accurate diagnosis rates were 86.7% (26/30) with fluoroscopic guidance and 91.7% (11/12) with CT guidance (P > 0.05). The complication rate of PCNB was 7.1% (3/42), including hemoptysis (n=2) and pneumothorax (n=1). The complication rate was 6.7% (2/30) with fluoroscopic guidance and 8.3% (1/12) with CT guidance (P > 0.05).CONCLUSION PCNB with an automated gun is useful for the pathologically conclusive diagnosis of small lung nodules (≤10 mm in diameter) using fluoroscopic or CT guidance. Key words: • X-ray computed tomography • fluoroscopy • lung diseases • biopsyP ercutaneous core needle biopsy (PCNB) of the lung is a well-established method for the cytological diagnosis of pulmonary nodules (1, 2). PCNB is generally regarded as a safe procedure with limited morbidity and extremely rare mortality (2-5). Biopsies of pulmonary lesions as small as 3 mm in diameter have been reported (6, 7). Diagnostic accuracy rates of 90%-100% using computed tomography (CT) guidance have been documented for pulmonary lesions greater than 10 mm in diameter (3,8). For smaller lesions, however, several studies have reported decreased diagnostic accuracy in the range of 52%-88% (3, 8, 9). Moreover, no study has reported a pathologically conclusive diagnosis of PCNB for small lung nodules using CT and fluoroscopy guidance.The purpose of this study was to evaluate the accurate diagnosis and complication rates of PCNB using an automated gun for small lung nodules with diameters <10 mm. Materials and methods PatientsBetween July 2004 and October 2011, 1467 consecutive percutaneous thoracic biopsies using automated biopsy devices or fine needle aspiration were performed at our institution. Of these cases, 81 extrapulmonary thoracic lesions, such as mediastinal (n=45), chest wall (n=21), and pleural (n=13) lesions were excluded. The remaining 1386 cases of PCNB were performed on pulmonary parenchymal lesions. The enrolled population consisted of 875 males (63.1%) and 511 females (36.9%). Patients' age ranged from 8 to 88 years (mean, 66.2 years). Using axial CT scan images, the largest transverse cross-sectional diameter of each nodule was measured on picture archiving and communication system workstations. The mean diameter of each nodule was considered as its size.Of the 1386 evaluable cases, there were 52 cases of initial PCNB and 10 cases of fine needle aspiration for small nodules with diameters <10 mm. Of these cases, 42 patients receiving an initial PCNB were enrolled in this study. The enrolled group consisted...

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confidence: 99%

Percutaneous core needle biopsy for small lung nodules with diameters ≤ 10 mm: accurate diagnosis and complication rates

Jae

June²,

Yie³

et al. 2012

Diagn Interv Radiol

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“…7 8 Similarly, sensitivity of TNAB for the specific benign diagnosis was reported to range from 11.7% to 68%. [7][8][9][10] Reappraisal of the usefulness of TNAB in the diagnosis of localised pulmonary lesions requires a better understanding of its accuracy. We therefore conducted a systematic review and meta-analysis with the following objectives: (1) to determine the operating characteristics of TNAB for the diagnosis of malignancy presenting as localised solitary or multiple parenchymal lesions; and (2) to identify characteristics of the TNAB technique that influence the diagnostic performance of the test.…”

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confidence: 99%

Transthoracic needle aspiration biopsy for the diagnosis of localised pulmonary lesions: a meta-analysis

Lacasse

Wong²,

Guyatt³

et al. 1999

Thorax

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Background-Persisting controversy surrounds the use of transthoracic needle aspiration biopsy (TNAB) stemming from its uncertain diagnostic accuracy. A systematic review and meta-analysis was therefore conducted to evaluate the accuracy of TNAB for the diagnosis of solitary or multiple localised pulmonary lesions. Methods-Searches for English literature papers in Index Medicus (1963)(1964)(1965) and Medline (1966Medline ( -1996 were performed and the bibliographies of the retrieved articles were systematically reviewed. Articles evaluating the accuracy of TNAB in series of consecutive patients presenting with solitary or multiple pulmonary lesions were considered. Only papers in which >90% of patients were given a final diagnosis according to an appropriate reference standard were included in the meta-analysis. Results-A total of 48 studies were included and five meta-analyses were conducted according to four diagnostic thresholds. From the pooled sensitivity and specificity corresponding to each diagnostic threshold, associated likelihood ratios (LRs) were derived for malignant disease as follows: (1) malignant versus all other categories, LR = 72; (2) malignant or suspicious versus all others, LR = 49; (3) suspicious versus all categories but malignant, LR = 15; (4) benign versus all others, LR = 0.07; and (5) specific benign diagnosis versus all others, LR = 0.005. DiVerences in methodological quality of the studies, needle types, or whether a cytopathologist participated in the procedure failed to explain the heterogeneity of the results found in almost every metaanalysis. Given a 50% probability of malignancy prior to the TNAB, post-test probabilities of malignancy upon receiving the results would be malignant, 99%; suspicious, 94%; non-specific benign, 7%; and benign with a specific diagnosis, 0.6%. Conclusions-Given the intermediate pre-test probabilities that would probably lead to performing TNAB, findings of "malignant" or of a specific diagnosis of a benign condition provide definitive results. Findings of "suspicious" markedly increase the probability of malignancy, and "benign" markedly decreases it but may not be considered definitive.

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“…experience with the technique [1]. Treatment of postbiopsy pneumothorax, when necessary, has traditionally been with large-bore (22-to 32-French) chest tubes.…”

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confidence: 99%

A one-piece unit for treatment of pneumothorax complicating needle biopsy: evaluation in 10 patients.

Molina¹,

Solomon²,

Glazer³

et al. 1990

American Journal of Roentgenology

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Percutaneous transthoracic needle aspiration: a review

Cited by 140 publications

References 32 publications

Percutaneous core needle biopsy for small lung nodules with diameters ≤ 10 mm: accurate diagnosis and complication rates

Percutaneous core needle biopsy for small lung nodules with diameters ≤ 10 mm: accurate diagnosis and complication rates

Transthoracic needle aspiration biopsy for the diagnosis of localised pulmonary lesions: a meta-analysis

A one-piece unit for treatment of pneumothorax complicating needle biopsy: evaluation in 10 patients.

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