Ultrathin needle (25�G) aspiration lung biopsy: diagnostic accuracy and complication rates

Abstract

The aim of this study was to evaluate the diagnostic accuracy and complication rate of 25-G fine-needle aspiration biopsy (FNAB) of the lung in patients with suspected malignant focal lesions and abnormal lung function. The 25-G FNAB was performed in 123 patients who underwent prebiopsy CT and pulmonary function tests. Retrospective evaluation included pulmonary function, cytology, size of the lesion, depth of location, presence of emphysema on CT, needle passes, pneumothorax and drainage. The final diagnosis (gold standard) was based on histopathology after surgical resection or follow-up and response to treatment. Sixty-one patients had normal lung function or mild impairment (group 1) and 62 had moderate or severe impairment (group 2). Pneumothorax occurred in 26 of 126 procedures (20.6%) with drainage needed in 11 (8.7%). In group 2 pneumothorax occurred in 19 of 63 procedures (30.15%) with drainage needed in 11 (17.5%). The sensitivity, specificity and diagnostic accuracy of cytology results were 93.6, 100 and 94.4%, respectively. FEV1 ( p=0.014), FEV1/FVC ( p=0.005), FEF25-75 ( p=0.001), DLCO ( p=0.013) and presence of emphysema on CT ( p<0.001) correlated with pneumothorax (Student's t test). The 25-G lung FNAB is accurate and safe in diagnosing malignancy in patients with severe lung functional abnormality. Patients with moderate to severe airway obstruction have a higher prevalence of pneumothorax than patients with mild or no functional impairment.

Value of high-resolution ultrasound in detecting a pneumothorax

“…In our study, pneumothorax occurred in 36% of cases, which is a slightly higher rate than those (19-30%) reported in recent reports [18][19][20][21]. This may be caused by differences in biopsy techniques.…”

Factors influencing accuracy of CT-guided percutaneous biopsies of pulmonary lesions

“…Recent reports have shown a high rate of specific diagnoses for both benign and malignant lesions following biopsy using automated biopsy devices [5,6,8]. There are also reports of excellent results using fine-needle aspiration [1,12,13], and recently ultrathin (25-G) fine needles have been shown to provide excellent diagnostic accuracy [14]. The value of adding histology to cytology has been shown using two different needles in the same coaxial system [6].…”

Evaluation of chronic infectious interstitial pulmonary disease in children by low-dose CT-guided transthoracic lung biopsy

“…In adult patients CT-guided TLB is predominantly used to establish a histological diagnosis in lung tumours and to differentiate between primary malignant pulmonary lesions and metastases of extrathoracic tumours [16][17][18]. CT-guided TLB enables a brilliant overview during the biopsy procedure by precisely documenting correct localization of the biopsy needle and its topographic relation to surrounding structures such as intrathoracic vessels [1].…”

“…The risk of developing pneumothorax or intraparenchymal haemorrhage after CT-guided TLB has been reported to be 9-54.7% requiring drainage in 2-20.5% of adult patients [18,19,[40][41][42][43][44]. Several factors have an impact on the risk of developing pneumothorax including small lesion size [19,42], lesion depth and location [42,44], angle of the biopsy needle [45], patient age, duration of the procedure, severe emphysema [18,19,44], and obstructive lung disease [44]; thus the risk in children, who usually do not suffer from severe emphysema, is reduced.…”

“…Several factors have an impact on the risk of developing pneumothorax including small lesion size [19,42], lesion depth and location [42,44], angle of the biopsy needle [45], patient age, duration of the procedure, severe emphysema [18,19,44], and obstructive lung disease [44]; thus the risk in children, who usually do not suffer from severe emphysema, is reduced. Although the pneumothorax rate has been shown to be independent of needle size in adults [19,46], we decided to use a small 20-gauge needle.…”