Diagnostic accuracy and safety of CT-guided percutaneous lung biopsy for peripheral lesions

INTRODUCTION
CT-guided percutaneous core needle biopsy (PCNB) is a well-established method for the histological diagnosis of pulmonary lesions. There is abundant literature
regarding the diagnostic yield of and complications associated with CT – guided PCNB. Many studies have investigated the risk factors influencing pneumothorax. Conversely, there are a limited number of reports detailing techniques for reducing the incidence of pneumothorax or other complications.
OBJECTIVE
Th is study aimed to assess the diagnostic accuracy and safety of this procedure.
MATERIAL AND METHODS
Th is study included 50 patients suspected to have lung cancer, treated in General Hospital 8th September. CT-guided PCNB was performed using a 20-gauge coaxial cutting needle in all patients with peripheral lung lesion where transbronchial examination failed in diagnosis. Aft er the biopsy, the patients were observed in the ward and positioned with the puncture side down. Immediate post-procedure CT images were obtained in selected cases according to the operator’s preference. In accordance
with the protocol, chest radiography was performed 4 h aft er the biopsy to rule out complications such as pneumothorax and hemorrhage. In cases showing pneumothorax
development, conservative treatment was administered with supplemental oxygen and monitoring of vital signs. In patients who showed signs of respiratory distress or a
large amount of pneumothorax, a chest tube was inserted. Patients who did not have complications or had minimal pneumothorax were discharged the following day. Patient-related variables such as age, sex, smoking history (never smoker, ex-smoker, or current smoker), and results of the pulmonary function test (forced vital capacity [FVC] were recorded. Th e lesion-related information included the location (upper, middle, and/or lower lobe), size (long-axis diameter on axial CT images) and nodule density (solid or subsolid). In addition, the presence of emphysema was evaluated.
RESULTS
Th e diagnostic accuracy, sensitivity, specificity, and percentage of nondiagnostic results for PCNB were determined in comparison with the final diagnosis. Additionally,
the risk factors for nondiagnostic results and pneumothorax were analyzed. For central lung cancer and endobronchial lesions, biopsy under flexible bronchoscopy had a sensitivity of 86% for diagnosing lung cancer. However, the diagnostic yield of bronchoscopy for peripheral lesions was lower, with a sensitivity of 30%. On the other hand, CT-guided biopsy is highly sensitive for diagnosing peripheral lung cancer. The overall diagnostic accuracy, sensitivity, and specificity of PCNB were 86.2%, 84.5%, and 88.2%, respectively. Th e percentage of nondiagnostic results was 16.0% (8/50). Two or less biopsy sampling was a risk factor for nondiagnostic results (p = 0.003). The overall complication rate was 30% (15/50), and pneumothorax developed in 10 patients (20%), 5 patients (10%) had minor transient hemoptysis. Drainage was performed in 5
patients (10%), and in 5 patients (10%), pneumothorax resolved spontaneously. A long transpulmonary needle path was a risk factor for the development of pneumothorax
(p = 0.006). Emphysema was present in 14 patients, mean FEV1% of the patients was 68%, mean FVC 81%, PaO2 9.1kPa, PaCO2 4.7kPa.
CONCLUSION
CT-guided PCNB using a coaxial needle is an effective method with reasonable accuracy and an acceptable complication rate for the diagnosis of lung cancer. CT guided lung biopsy may be considered, particularly for lung lesions that have achieved diagnostic failure by transbronchial examination, are located in peripheral areas, or have ground-glass nodules (GGNs).
KEYWORDS
Lung cancer, CT-guided percutaneous lung biopsy, peripheral lung lesion,
bronchoscopy