CT-guided Lung Biopsy: Factors Influencing Diagnostic Yield and Complication Rate
Introduction
Computed tomography (CT)-guided lung biopsy was first described in 1976 [1]. Since then, after a great deal of work to refine its safety and diagnostic accuracy, it has become a widely used diagnostic tool in the management of patients with suspected lung cancer. Diagnostic accuracies of 82–96% have been reported 2, 3 with acceptable complication rates; the incidence of pneumothorax is reported as 22–45% 3, 4, 5. Traditionally, fine-needle aspirate biopsies were performed, because of the unacceptable morbidity and mortality associated with pulmonary haemorrhage after core biopsy 6, 7. More recently, the availability of smaller gauge, spring-loaded core biopsy needles has revived interest in their use, given the reduced incidence of pulmonary haemorrhage and the accepted limitations of cytological analysis of fine-needle aspiration (FNA) samples. One main limitation of aspiration biopsies is the operator's inability to assess the adequacy of the sample visually. The presence of a cytopathologist, to confirm that diagnostic material has been obtained, has been shown to improve diagnostic yield [8], but if this resource is not available, it has been suggested that core biopsies should be obtained routinely [9]. Studies to establish other factors that affect diagnostic yield have been limited, although there has been much more published on the factors affecting the incidence of pneumothorax. We undertook this study of 5 years of our own experience to assess factors affecting diagnostic accuracy, with specific reference to the differences between core biopsy (which was used increasingly during this period) and FNA biopsy. Factors affecting the frequency of pneumothorax were also studied.
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Materials and Methods
Between August 1995 and September 2000, 195 CT-guided lung biopsies were performed on 182 patients, 11 patients having two biopsies and one patient having three biopsies. These cases were identified retrospectively using the Radiology Information System (Ricketts System).
Patients were referred by the respiratory physicians after multidisciplinary discussion at weekly clinical meetings. Patients with severe chronic obstructive pulmonary disease (COPD) (FEV1 <1 l) or previous pneumonectomy, those
Results
One hundred and ninety-five biopsies were performed on 182 patients: 11 patients had two procedures and one patient had three procedures. One hundred and three patients were male and 79 were female. The average age was 67.5 years (range 29–87 years). The average size of the lesions was 41 mm (range 8–100 mm). One hundred and two lesions were contiguous with the pleural surface: the average depth of all other lesions from the pleural surface was 24 mm (range 5–70 mm). One hundred and fifty-one
Discussion
Patients with intrapulmonary masses of unclear aetiology present clinicians with a diagnostic problem. The causes of such masses encompass a wide range of both benign and malignant processes with a diverse range of treatment options. Because of the revolution in available treatment options, it has become increasingly important to reach a definitive diagnosis for such patients in a timely fashion. Furthermore, because of the widespread availability of CT, increasing numbers of small pulmonary
Acknowledgements
We are grateful to Dr Kendra Murray, Consultant Pathologist, for her help in the acquisition of pathological results, and to Dr Joanne Moncrieff for statistical advice.
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