CT-guided percutaneous fine-needle aspiration biopsy of small (< or =1-cm) pulmonary lesions

PURPOSE: To determine the accuracy of percutaneous computed tomography (CT)-guided fine-needle aspiration biopsy (FNAB) of small (< or =1.0-cm in diameter) pulmonary lesions. MATERIALS AND METHODS: Sixty-one patients (34 men and 27 women) 21-89 years old (mean age, 61.3 years) with lung nodules 1.0 cm or smaller underwent CT-guided transthoracic FNAB. Fifty-seven of the 61 patients had an underlying primary malignancy. Maximum nodule diameters were 0.5-0.7 cm in 10 patients and 0.8-1.0 cm in 51 patients. Cytopathologic evaluation of FNAB samples was immediate in all patients. Sensitivity and accuracy were calculated, and each case was reviewed for complications, including pneumothorax and thoracostomy tube insertion. Four patients were not included in our statistical analysis because of a lack of follow-up information. RESULTS: FNAB samples were adequate for diagnosis in 47 (77%) of 61 patients. Diagnoses were malignancy (n = 29) or suspected malignancy (n = 3) in 52% (n = 32) and benign or atypical findings in 25% (n = 15). Findings were nondiagnostic in 23% (n = 14). Of the 29 patients without evidence of malignancy, 25 had follow-up findings available. Follow-up included chest CT in 16 patients and surgical resection in nine. Four patients were not included in statistical analysis because of a lack of follow-up information. Overall sensitivity was 82% (32 of 39); specificity, 100% (18 of 18); and diagnostic accuracy, 88% (50 of 57) on the basis of 57 patients being evaluable. Results for 47 0.8-1.0-cm lesions were considerably better (sensitivity, 88%; accuracy, 92%) than those for 10 0.5-0.7-cm lesions (sensitivity, 50%; accuracy, 70%). Sensitivity (75% vs 87%) and accuracy (87% vs 89%) also improved when comparing subpleural (< or =1.0 cm from pleural surface, n = 30) with deeper (>1 cm from pleural surface, n = 27) pulmonary lesions, but the improvement did not indicate statistical significance. Core biopsy did not reveal malignancy in any of the nine patients in whom preliminary cytologic results were inconclusive and did not improve diagnostic yield. Thirty-eight (62%) patients had pneumothorax, with 19 (31%) requiring thoracostomy tube placement. CONCLUSION: CT-guided FNAB of pulmonary lesions 1.0 cm or smaller can yield high diagnostic accuracy rates approaching those of larger lesions; FNAB of 0.8-1.0-cm lesions that are not subpleural offers the best opportunity for success.     

CT-guided transthoracic needle biopsy of pulmonary nodules smaller than 20 mm: results with an automated 20-gauge coaxial cutting needle

AIMS: To evaluate the efficacy and the complication rate of CT-guided percutaneous lung biopsy of pulmonary nodules smaller than 20 mm in diameter using a 20-gauge coaxial automated biopsy device. MATERIAL AND METHODS: A prospective study was undertaken of 200 patients who underwent 202 consecutive biopsies of pulmonary nodules, performed with a single type of automated biopsy device. Sixty-seven biopsies of nodules smaller than 20 mm in diameter were performed in 66 patients (group A). One hundred and thirty-five biopsies of lesions of 20 mm or greater in size were performed in 134 patients (group B). Patient characteristics, lesion and procedure variables, the accuracy and complication rates were compared. RESULTS: In group A, the final diagnosis of the nodules was malignant in 47 and benign in 19 cases (prevalence of malignancy 71. 2%). In group B, there were 111 malignant and 21 benign diagnoses (prevalence of malignancy 82.2%). In group A, the sensitivity and specificity for a diagnosis of malignancy were 89.5 and 100%, respectively (positive predictive value 100%, negative predictive value 76%). A specific diagnosis of benignity was obtained in nine out of 19 (47%) biopsies. The pneumothorax rate was 15% (10 patients) of which two (3%) required drainage. CT signs thought to reflect alveolar haemorrhage were noted in 28 (43%) and haemoptysis occurred in five patients (5.9%). In group B, the sensitivity and specificity for a diagnosis of malignancy were 95.5% and 100%, respectively (positive predictive value 100%, negative predictive value 82.7%). A specific diagnosis of benignity was made in 14 cases (58.3%). Complications included pneumothoraces in 22 cases (16.2%) requiring drainage in one (0.7%). Presumed alveolar haemorrhage was recorded in 19 cases (14.1%) and haemoptysis occurred in seven (5. 2%). There were no significant differences between group A and group B, except for alveolar haemorrhage (P < 0.001). CONCLUSION: The accuracy and complication rate of percutaneous CT-guided biopsy of nodules smaller than 20 mm, performed using an automated 20-gauge coaxial biopsy device, are comparable to those for larger lesions.     

CT-guided percutaneous fine-needle aspiration biopsy of pulmonary nodules measuring 10 mm or less

AIM: To determine the value of computed tomography (CT)-guided fine-needle aspiration biopsy (FNAB) of small pulmonary nodules measuring 10 mm or less. MATERIAL AND METHODS: CT-guided FNABs of 55 nodules, measuring 10mm or less, were performed between January 2003 and February 2006. A coaxial technique was used, with an outer 19 G Bard Truguide needle and inner 22 G disposable Greene biopsy needle. Adequacy of specimens was assessed on-site by a cytotechnologist. The sizes of the nodules, distance from pleura, number of pleural punctures and aspirates, complications encountered, cytological diagnosis, and outcome were recorded. RESULTS: The mean nodule diameter was 9 mm (range 5-10 mm). The average distance from the costal pleura was 31 mm (range 0-88 mm). In 50 of the 55 FNABs, the pleura was crossed once. An average of four aspirates was performed per case. Twenty-five FNABs (45.5%) were adequate for diagnosis (24 malignant and one tuberculosis). In 11 cases, where no definite diagnosis was made following FNAB, the outcome was not affected. In 10 cases, samples were insufficient for diagnosis and the nodules were subsequently diagnosed as malignant. Eight cases were excluded in the final analysis as follow-up details were unavailable. The sensitivity for malignancy and overall accuracy were 67.7 and 78.8%, respectively. Pneumothorax occurred in 29 (52.7%) patients, with five (9.1%) requiring thoracostomy tubes. CONCLUSION: CT-guided FNAB is a useful tool in the diagnosis and management of small pulmonary nodules, despite the lower diagnostic accuracy and higher complication rate than those of larger pulmonary lesions.     

Safety and diagnostic accuracy of percutaneous CT-guided transthoracic biopsy of small lung nodules (≤20 mm) adjacent to the pericardium or great vessels

PURPOSEWe aimed to evaluate the safety and diagnostic accuracy of computed tomography (CT)-guided transthoracic biopsy of small lung nodules (≤20 mm) adjacent to the pericardium or great vessels.METHODSThis retrospective study examined the safety and diagnostic accuracy of percutaneous CT-guided biopsy for small lung nodules (≤20 mm) located within 10 mm of the pericardium or great vessels. Technical aspects and factors influencing complications were assessed, and diagnostic accuracy was calculated.RESULTSA total of 168 biopsies were performed in 168 patients. The complications were mainly pneumothorax (34.5%; 58 of 168 patients), chest tube insertion (5.3%; 9 of 168 patients), and pulmonary hemorrhage (61.3%; 103 of 168 procedures), with no patient mortality. One patient (0.6%) was admitted because of hemorrhage complications. Significant independent risk factors for pneumothorax were nodules resided in upper or middle lobes and lateral patient position, and for hemorrhage, longer distance from structures and longer needle trajectory through the lung parenchyma. Overall, the sensitivity, accuracy, and specificity were 91.0%, 92.2%, and 100%, respectively.CONCLUSIONPercutaneous CT-guided transthoracic biopsy was highly accurate in small lung nodules (≤20 mm) adjacent to the pericardium or great vessels. Complications are common, but most were minor and self-limited.

In recent years, with wide availability of computed tomography (CT) and the development of low-dose CT screening techniques, more small lung nodules (≤20 mm) have been detected (1–3). Lee et al. (4) reported that small lung nodules were detected at a rate of 44.5%, and that 39.7% of lung cancers were found in small nodules. Accurate histopathological diagnosis is of great importance in management of these nodules, but biopsy via fluoroscopy or ultrasound guidance is technically more difficult, and CT guidance is usually required (5).Percutaneous CT-guided transthoracic lung biopsy is a reasonably safe and accurate approach to the histological diagnosis of primary and secondary lung nodules (4, 6, 7). However, nodule size is the major determinant of diagnostic accuracy, which reached 96.9% for larger nodules (7), but ranged from 52% to 78.8% for small nodules (8, 9).Biopsy of small lung nodules close to proximity to the pericardium or great vessels is particularly challenging, and precise needle placement is essential to avoid complications resulting from non-target tissue injury near vital mediastinal or vascular structures. Hsu et al. (10) suggested that CT-guided lung biopsy should be avoided if the adjacent nodule is within 10 mm of the pericardium.The authors know of no related studies of biopsy of small lung nodules close to the pericardium or great vessels. This study, therefore, was conducted to examine the safety and diagnostic accuracy of CT-guided transthoracic biopsy of small lung nodules (≤20 mm) within 10 mm of the pericardium or great vessels.     

CT-guided transthoracic needle biopsy of pulmonary lesions: comparison between the cutting needle and aspiration needle

Objectives:To compare CT-guided transthoracic cutting needle biopsy (TCNB) with transthoracic aspiration needle biopsy (TANB) for pulmonary lesions with respect to the diagnostic accuracy and complication rate.Methods:Of the 859 cases that underwent consecutive CT-guided biopsy of pulmonary lesions, 713 cases confirmed by surgical pathology or clinical follow-up were enrolled. Of these, the first consecutive 275 cases underwent TANB, and the remaining 438 received TCNB. The final diagnosis determined the accuracy of biopsy. Based on the post-biopsy CT and clinical medical records, the presence or absence of biopsy-related complications was determined. The χ² test was used to compare the differences between TCNB and TANB in terms of diagnostic accuracy and complication rate.Results:Among the 713 biopsy lesions, the final diagnosis was malignant in 411 cases and benign in 302 cases. As compared to TANB, the diagnostic accuracy of TCNB (98.9% vs 93.8%, χ² = 14.35, p < 0.01), sensitivity to malignant lesions (97.8% vs 90.6%, χ² = 10.58, p < 0.01), negative predictive value (97.6% vs 84.8%, χ² = 19.03, p < 0.01), and specific diagnostic rate for benign lesions (73.4% vs 57.9%, χ² = 7.29, p < 0.01) were improved. On the other hand, a statistical difference was detected between TCNB and TANB with respect to the incidence of pneumothorax (20.6% vs 13.1%, χ² = 6.46, p = 0.01), hemorrhage (32.2% vs 13.1%, χ² = 33.03, p < 0.01), and hemoptysis (8.2% vs 3.3%, χ² = 6.87, p < 0.01). One patient died just several minutes after TCNB due to severe hemorrhage with hemoptysis.Conclusions:Compared to TANB, CT-guided TCNB improves the diagnostic accuracy of pulmonary lesions, but complication rate increases significantly.Advances in knowledge:In general, TCNB should be recommended, especially for highly suspicious benign lesions. For patients with small lesions adjacent to vessels or vessels within the lesion, TANB should be considered.     

CT-guided needle biopsy of small pulmonary nodules: value of respiratory gating

A respiratory gating technique was developed to allow computed tomography-guided needle biopsy of small pulmonary nodules. Twenty-three pulmonary nodules less than 15 mm in diameter underwent biopsy with the use of this technique. There were 14 true-positive, eight true-negative, and one false-negative result (diagnostic accuracy, 96%). The diagnostic accuracy for small nodules without this technique in a historical control was 69% (P: <.05).     

Diagnostic efficacy of CT-guided transthoracic needle biopsy and fine needle aspiration in cases of pulmonary infectious disease

Purpose

The purpose of our study was to evaluate the efficacy of computed-tomography (CT)-guided transthoracic needle biopsy (TNB) and fine needle aspiration (FNA) in diagnosing pulmonary infectious diseases.

Patients and methods

We retrospectively reviewed the medical records of patients treated at our institution between October 2006 and September 2009 and identified 161 patients who had undergone CT-guided TNB or FNA. We conducted CT-guided TNB or FNA for the patients if bronchoscopy failed to provide proper diagnosis or if their thoracic lesions were not appropriate targets for bronchoscopy.

Results

Twenty-three patients were diagnosed with pulmonary infectious diseases, of whom 17 were diagnosed by CT-guided TNB or FNA; sensitivity was therefore 73.9?% (17/23). The diagnostic rate for Aspergillus infection was especially high (75?%).

Conclusion

CT-guided TNB and FNA proved to be effective as alternative methods if bronchoscopy failed to diagnose pulmonary infectious diseases, with acceptable complication rates.     

直径3cm以下肺孤立性病灶的CT引导下经皮肺穿刺活检

目的:评价直径3cm以下肺孤立性病灶的CT引导下经皮肺穿刺活检的价值。方法:68例直径3cm以下肺孤立性病灶在CT引导下,采用抽吸式活检针,选择最佳穿刺层面及穿刺点获取标本。结果:本组病例共行84次穿刺活检,获得细胞学涂片检查者68例,获得组织学检查59例。总的诊断准确度为89.7%,其中细胞学和组织学标本诊断准确度分别为662%(45/68)和81.4%(48/59)。阳性预告值和阴性预告值分别为100%(51/51)和58.8%(10/17)。并发症:气胸16例(23.5%),出血5例(7.4%),咯血4例(5.9%)。结论:CT引导下经皮肺穿刺活检是一种创伤小而实用的定性诊断方法,对直径3cm以下肺孤立性病灶的诊断具有较高的临床应用价值。     

Special techniques in transthoracic needle biopsy of pulmonary nodules

We believe that each aspect of the performance of TNB needs to be considered carefully. Meticulous attention to detail allows any nodule in the chest to successfully undergo biopsy. There are techniques of needle tip repositioning that can be quite helpful for obtaining diagnostic material from lung lesions, particularly small nodules. A strong working relationship with pathologists experienced in lung cytology is a vital element of any successful biopsy program. Techniques available to the pathologist allow for quick and decisive determination of the adequacy of the aspirated specimen and help guide the radiologist performing the procedure. Newer cytopathologic techniques help the pathologist make more complex diagnoses from the aspirated material. Finally, techniques used to minimize complications should be considered by the operator before the performance of the biopsy.     

CT透视引导下胸部小病灶穿刺活检的临床价值

目的探讨CT引导胸部小病灶穿刺活检技术及诊断价值。方法 50例胸部小病灶(<3 cm)在CT引导下采用自动切割式活检针穿刺活检。结果50例胸部肿块穿刺活检病灶取材成功100%。胸部肿块穿刺活检的诊断准确率96%(48/50),对恶性病变诊断准确率97.5%(39/40),良性病变为90%(9/10)。并发气胸2例,少量出血1例。结论 C T引导下穿刺活检是安全、有效的诊断手段,对于胸部病变诊断的准确率高,CT引导下胸部小病灶穿刺活检对胸部病变的诊断和治疗具有重要意义。     

CT引导下经皮肺穿刺活检术后气胸发生率的相关因素分析

目的分析影响CT引导下经皮肺穿刺活检术后气胸发生率的因素。方法观察162例CT引导下经皮肺穿刺活检术后患者气胸发生的情况（病灶直径1～6cm），分析其出现的相关因素并行非条件Logistic回归。结果术后CT发现气胸32例，发生率为19．8％。X^2检验表明患者是否合并慢性肺阻塞性疾病（COPD）、病灶与胸壁的距离、穿刺针停留时间及病灶直径等4个因素与气胸发生率有关。其中COPD患者67例术后发生气胸22例（32．8％）；病灶紧贴胸壁（48例）、病灶与胸壁距离〈2cm（55例）及病灶与胸壁距离〉2cm（59例）患者术后发生气胸分别为0、14（25．5％）、18例（30．5％）；穿刺针在胸腔内停留时间〈10min（83例）、10～20min（51例）、〉20min（28例）的患者术后发生气胸例数分别是8（9．6％）、10（19．6％）、14（50．0％）例；病灶直径〈2cm（65例）、2～4cm（52例）、〉4cm（45例）的患者术后发生气胸分别是19（29．2％）、8（15．4％）、5（11．1％）例。其中前3项经多因素Logistic回归分析，是气胸发生的危险因素（其OR值分别为4．652，4．030，2．855）。结论当病灶离胸壁远，患者合并有COPD，病灶直径小的患者，穿刺前要充分考虑到气胸发生的可能，减少穿刺针在胸腔内停留时间，可使CT引导下经皮肺穿刺活检术后气胸发生率大为降低。     

经皮肺活检对肺部病变的临床诊断意义

目的 评价经皮肺活检术对原发性肺癌、肺转移性癌以及非恶性肺疾病的诊断价值.方法 回顾性总结近10年来436例经皮肺活检患者的临床资料,其中明确为原发性肺癌患者341例、肺转移性癌62例、非恶性肺疾病33例.统汁分析经皮肺活检术对上述疾病的诊断准确率及灵敏度.结'果原发性肺癌组经皮肺活检阳性321例,诊断准确率为94.7%、灵敏度94.1%;肺转移性癌组阳性32例,诊断准确率58.2%、灵敏度51.6%;非恶性肺疾病组阳性19例,诊断准确率以及灵敏度均为57.6%.436例患者中427例经皮肺活检获得足够病变组织标本,9例活检失败,活检成功率97.9%.全部患者共穿刺474例次,其中74例次出现并发症,发生率15.6%.主要并发症有气胸(63例次,13.3%)和肺内出血(56例次,11.8%).结论 临床上怀疑原发性肺癌的肺部病变,经皮肺活检术诊断准确率高,并发症少且轻微.对于考虑为肺转移性癌以及非恶性肺疾病,该技术尚有待进一步改进.     

64排螺旋CT导向经胸穿刺活检对评价肺部小结节的临床应用

目的探讨64排螺旋CT导向肺部小结节经胸穿刺活检的准确性及临床应用价值。方法收集有手术病理或临床随访结果的肺部小结节（直径小于2cnl）CT导向经胸穿刺活检者118例，其中经64排螺旋CT导向57例，经普通CT导向61例。比较64排螺旋CT导向和普通CT导向肺部小结节穿刺活检在诊断正确率和并发症发生率的差异。结果64排螺旋CT导向肺深部小结节穿刺活检诊断正确率91．23％（52／57）高于普通CT导向的诊断正确率77．05％（47／61），差异有显著性意义（P〈0．05）。64排螺旋CT导向肺部小结节穿刺活检的并发症发生率14．04％（8／57）低于普通CT的并发症发生率26．23％（16／61），但差异无统计学意义（P〉0．05）。结论与普通CT比较，64排螺旋CT导向肺部小结节穿刺活检是一种更安全、准确的诊断和鉴别诊断方法。     

Complications of percutaneous transthoracic needle aspiration biopsy.

After 5,300 percutaneous transthoracic needle aspiration biopsy procedures in 2,726 patients pneumothorax occurred in 27.2 per cent of the patients. Only 7.7 per cent required exsufflation or drainage. The factors influencing the relative frequency and the severity of pneumothorax are discussed. Bleeding around the punctured lesions was found in 11 per cent, and hemoptysis in 2 per cent but were of no clinical importance. In one case evidence of needle track implantation was found. The theoretical and practical importance of tumour cell spread and spread of infection through the needle track is discussed. No air embolism or mortality occurred.