Thoracic Needle Biopsy

Conces, Dewey J.; Schwenk, G. R.; Doering, P; Glant, Michael D.

doi:10.1378/chest.91.6.813

Cited by 66 publications

(6 citation statements)

References 10 publications

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“…In the six cases with no obvious source of error, the presence of on-site cytopathology assessment at the time of the biopsy procedure, for evaluation of either a fine needle aspiration sample or a touch prep of a CNB, may be helpful to determine tissue viability and predict the adequacy of subsequent CNBs taken from the area. 41–45 Based on this error analysis, forthcoming clinical trials (BATTLE-2 and BATTLE-FL) have incorporated the use of real-time cytopathology assessment to determine tissue viability; and, if no clear lesion can be selected for biopsy based on the available diagnostic imaging, the IR has been requesting a FDG-PET/CT to optimize lesion selection prior to biopsy. It remains to be seen whether the implementation of these measures will improve diagnostic yield.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of Image-Guided Transthoracic Core-Needle Biopsy in the BATTLE Lung Trial

Tam

Kim

Lee

et al. 2013

Journal of Thoracic Oncology

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Purpose As therapy for non-small cell lung cancer (NSCLC) patients becomes more personalized, additional tissue in the form of core needle biopsies (CNBs) for biomarker analysis is increasingly required for determining appropriate treatment and for enrollment into clinical trials. We report our experience with small-caliber percutaneous transthoracic (PT) CNBs for the evaluation of multiple molecular biomarkers in BATTLE (Biomarker-integrated Approaches of Targeted Therapy for Lung Cancer Elimination), a personalized, targeted therapy NSCLC clinical trial. Methods The medical records of patients who underwent PTCNB for consideration of enrollment in BATTLE, were reviewed for diagnostic yield of 11 predetermined molecular markers, and procedural complications. Univariate and multivariate analyses of factors related to patient and lesion characteristics were performed to determine possible influences on diagnostic yield. Results One hundred and seventy PTCNBs were performed using 20-gauge biopsy needles in 151 NSCLC patients screened for the trial. 82.9% of the biopsy specimens were found to have adequate tumor tissue for analysis of the required biomarkers. On multivariate analysis, metastatic lesions were 5.4 times more likely to yield diagnostic tissue as compared to primary tumors (p = 0.0079). Pneumothorax and chest tube insertion rates were 15.3% and 9.4%, respectively. Conclusions Image-guided 20-gauge PTCNB is safe and provides adequate tissue for analysis of multiple biomarkers in the majority of patients being considered for enrollment into a personalized, targeted therapy NSCLC clinical trial. Metastatic lesions are more likely to yield diagnostic tissue as compared to primary tumors.

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Section: Discussionmentioning

confidence: 99%

“…Our recommendations are based partly on the results of the current study and partly on applying principles, such as on-site cytopathology assessment to improve yield, that have been tested previously in the diagnostic setting. 41–45 …”

Section: Discussionmentioning

confidence: 99%

Feasibility of Image-Guided Transthoracic Core-Needle Biopsy in the BATTLE Lung Trial

Tam

Kim

Lee

et al. 2013

Journal of Thoracic Oncology

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“…A definitive diagnosis of malignancy is yielded in 50-95% of malignant pulmonary lesions, depending upon their size and location. 4,[8][9][10]13,15,18 However, a definitive benign diagnosis is generally obtained in < 50% and may be as low as 12%. 3,6 There are two main limitations associated with the FNA technique: (1) the cytologic aspirate obtained provides a relatively small sample, sometimes from a noninvolved area (sample error), and (2) cytologic interpretive error may occur with disease processes that are better defined by an overall morphologic pattern rather than by individual cytologic features, so a specific diagnosis is infrequently obtained from aspirated cytologic material in benign lesions (Figures 1 and 2).…”

Section: Comparison Of Fna and Pcnb In The Specific Diagnosis Of Benimentioning

confidence: 99%

Percutaneous Core Needle Biopsy vs. Fine Needle Aspiration in Diagnosing Benign Lung Lesions

et al. 1999

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“…Other studies have also supported the utility and reliability of FNA in the diagnosis of intrapulmonary malignant tumors, with accuracy rates falling between 80 and 95% [15,16,17,18,19,20,21,22,23,24,25,26,27]. Specifically, in a direct comparison between FNA and CNB in the same patient, Gong et al [27] demonstrated that for malignant tumors the diagnostic accuracy of FNA was comparable to that of CNB, with an accuracy of 85.1 and 86.7%, respectively.…”

Section: Discussionmentioning

confidence: 93%

The Utility of Fine-Needle Aspiration in the Diagnosis of Primary and Metastatic Tumors to the Lung: a Retrospective Examination of 1,032 Cases

Adams

Wu²

2012

Acta Cytologica

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Background: With the emergence of improved treatment strategies for patients with malignant lung tumors, it has become increasingly important to adequately diagnose and subclassify lung lesions. In our large retrospective study, we assessed the utility of fine-needle aspiration (FNA) in the diagnosis of primary and metastatic tumors to the lung. Methods: A computerized search of our laboratory informatics system was performed to identify cases from FNA of the lung and FNA of metastatic lung cancers to other sites. All of the corresponding surgical pathology reports were also reviewed. All of the cases were categorized as atypical (A), benign (B), malignant (M), nondiagnostic (ND), or suspicious (S) for data analysis purposes. Results: A total of 1,032 FNA cases were categorized as follows: 34 (3.3%) A, 142 (13.8%) B, 717 (69.5%) M, 121 (11.7%) ND, and 18 (1.7%) S. Of the 717 cases of malignant FNA, a specific tumor type was able to be rendered on cytomorphology alone or with the help of immunostains in 99% as follows: adenocarcinoma (296 cases, 41%), squamous cell carcinoma (158 cases, 22%), metastatic tumors (123 cases, 17%), small cell carcinoma (56 cases, 8%), non-small cell lung carcinoma (NSCLC) (58 cases, 8%), neuroendocrine carcinoma (15 cases, 2%), and poorly differentiated carcinoma (4 cases, 1%). Out of all NSCLC cases, 89% were able to be subclassified as either adenocarcinoma or squamous carcinoma. The most frequent origins of metastatic tumors to the lung were renal cell carcinoma (n = 22), melanoma (n = 17), colon (n = 15), breast (n = 14), and urothelial carcinoma (n = 10). There was also metastasis from 18 other organs with fewer than 5 cases each. There were 333 correlated histologic specimens including 191 small biopsies and 142 resection specimens. Diagnostic sensitivity and specificity for malignancy were 96 and 100%, respectively. Diagnostic accuracy was 97%. Sampling error resulted in 8 false-negative cases on FNA. Conclusions: FNA is both sensitive and specific in the diagnosis and subclassification of both primary and metastatic lung tumors. Eighty-nine percent of NSCLC cases were able to be further subclassified as adenocarcinoma or squamous cell carcinoma by FNA.

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Thoracic Needle Biopsy

Cited by 66 publications

References 10 publications

Feasibility of Image-Guided Transthoracic Core-Needle Biopsy in the BATTLE Lung Trial

Feasibility of Image-Guided Transthoracic Core-Needle Biopsy in the BATTLE Lung Trial

Percutaneous Core Needle Biopsy vs. Fine Needle Aspiration in Diagnosing Benign Lung Lesions

The Utility of Fine-Needle Aspiration in the Diagnosis of Primary and Metastatic Tumors to the Lung: a Retrospective Examination of 1,032 Cases

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