Elsevier

Clinical Radiology

Volume 58, Issue 10, October 2003, Pages 791-797
Clinical Radiology

CT-guided Lung Biopsy: Factors Influencing Diagnostic Yield and Complication Rate

https://doi.org/10.1016/S0009-9260(03)00221-6Get rights and content

Abstract

AIM: To determine factors influencing diagnostic yield in computed tomography (CT)-guided biopsy of lung lesions.

MATERIALS AND METHODS: One hundred and ninety-five consecutive CT-guided lung biopsies were performed in 182 patients between August 1995 and September 2000 and either fine-needle aspirate samples for cytology or core biopsy samples for histology were collected. Procedures were divided into a diagnostic group (true-positive and true-negative results) and a non-diagnostic group (false-positive and false-negative results) and the factors affecting diagnostic accuracy assessed.

RESULTS: One hundred and fifty-six lesions (86%) were malignant, and 26 (14%) were benign. More than one biopsy was performed for 12 lesions. One hundred and thirty-two biopsies were true-positive, 27 true-negative and 36 false-negative. No false-positive results occurred in the study. Overall diagnostic accuracy was 81.5%. Significantly more core biopsies than fine-needle aspirates were diagnostic: 93 versus 78% (p<0.005). No difference was found in frequency of pneumothorax between these two groups. There was a difference in the average depth from the pleural surface of lesions in the diagnostic and non-diagnostic groups, but this did not attain statistical significance: 9.8 versus 17.2 mm (p=0.054).

CONCLUSION: In this study CT-guided lung biopsy core biopsy was a more accurate method of tissue sampling than fine-needle aspiration, and was not associated with an excess of complications.

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.

Section snippets

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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