PURPOSE: To evaluate the diagnostic yield and complication rate with core biopsies in patients with intrathoracal findings raising suspicion of malignancy. Core biopsies are valuable as they provide tissue samples of sufficient size for analysis to personalize and target treatment in lung cancer.
METHODS: Between Jan 2005 and Dec 2010 463 consecutive CT-guided core biopsies were performed. In 18 patients the biopsies were repeated. The population was 224 females and 239 males, mean age 68 years. Never smokers accounted for 21,5%, 33% were current smokers, 38% ex smokers and data missing in 7,5%. Sixty five percent of the patients had undergone bronchoscopy but without diagnosis, 84% of patients were referred from the department of respiratory medicine. Two radiologists with huge experience performed the majority of the biopsies. The material includes 377 biopsies of the lung (81%), 48 (10%) mediastinal biopsies and less than 10% pleural biopsies.
RESULTS: In 212 cases (46%) lung cancer was diagnosed, benign lesions were diagnosed in 188 (41%) and pulmonary metastases in 39 (8%). Other diagnoses were for example lymphoma, malignant mesothelioma, thymoma, solitary fibrous tumour of the pleura. In the 18 cases with repeated biopsy the diagnosis was changed to malignancy in 9 patients. In 119 patients a pneumothorax was observed at the CT directly after biopsy and of these 14 were evacuated with a thin needle at the department of radiology. Eleven of those were more than 20mm. All patients underwent a chest X-ray after 4 hours and pneumothorax was seen in 156 (34%) patients, 54 of whom had no sign of air leakage at the direct CT. Of these 27 (17%) were drained. Small intraparenchymal haemorrhages and hemoptysis were noticed but did not cause any problem except in one patient who developed a severe haemorrhage and needed intensive care. This patient was diagnosed with advanced lung cancer.
CONCLUSIONS: CT guided core biopsy is a valuable tool in obtaining sufficient tissue to ensure diagnosis with a low complication rate.
CLINICAL IMPLICATIONS: This method is applicable in a county hospital
DISCLOSURE: The following authors have nothing to disclose: Eva Brandén, Stig Wallgren, Hirsh Koyi
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