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Original Research: LUNG BIOPSY |

CT Fluoroscopy-Guided Biopsy of 1,000 Pulmonary Lesions Performed With 20-Gauge Coaxial Cutting Needles: Diagnostic Yield and Risk Factors for Diagnostic Failure

Takao Hiraki, MD; Hidefumi Mimura, MD; Hideo Gobara, MD; Toshihiro Iguchi, MD; Hiroyasu Fujiwara, MD; Jun Sakurai, MD; Yusuke Matsui, MD; Daisaku Inoue, MD; Shinichi Toyooka, MD; Yoshifumi Sano, MD; Susumu Kanazawa, MD
Author and Funding Information

Affiliations: From the Departments of Radiology (Drs. Hiraki, Mimura, Gobara, Iguchi, Fujiwara, Sakurai, Matsui, Inoue, and Kanazawa) and Cancer and Thoracic Surgery (Drs. Toyooka and Sano), Okayama University Medical School, Okayama, Japan.

Correspondence to: Takao Hiraki, MD, Okayama University Medical School, Radiology, 2-5-1 Shikatacho Okayama, Okayama 700-8558, Japan; e-mail: takaoh@tc4.so-net.ne.jp


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(6):1612-1617. doi:10.1378/chest.09-0370
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Background:  Although conventional CT scan-guided needle biopsy is an established diagnostic method for pulmonary lesions, few large studies have been conducted on the diagnostic outcomes of CT fluoroscopy-guided lung biopsy. We have conducted a retrospective analysis to evaluate the diagnostic outcomes of 1,000 CT fluoroscopy-guided lung biopsies performed with 20-gauge coaxial cutting needles.

Methods:  We determined the diagnostic yield of CT fluoroscopy-guided lung biopsies performed with 20-gauge coaxial cutting needles for 1,000 lesions in 901 patients. Independent risk factors for diagnostic failure (ie, nondiagnostic, false-positive, and false-negative results) were determined with multivariate logistic regression analysis.

Results:  The biopsy results were nondiagnostic in 0.6% of the lesions (6 of 1,000 lesions). The sensitivity and specificity for the diagnosis of malignancy was 94.2% (741 of 787 lesions) and 99.1% (211 of 213 lesions), respectively; diagnostic accuracy was 95.2% (952 of 1,000 lesions). For lesions measuring ≤ 1.0 cm, the diagnostic accuracy was 92.7% (140 of 151 lesions). The significant independent risk factors for diagnostic failure were as follows: the acquisition of two or fewer specimens (odds ratio [OR], 2.43; p = 0.007), lesions in the lower lobe (OR, 2.50; p = 0.003), malignant lesions (OR, 7.16; p = 0.007), and lesions measuring ≤ 1.0 cm (OR, 3.85; p = 0.016) and ≥ 3.1 cm (OR, 4.32; p = 0.007).

Conclusions:  CT fluoroscopy-guided lung biopsy performed with 20-gauge coaxial cutting needles resulted in a high diagnostic yield, even in the case of small lesions. Factors such as the acquisition of two or fewer specimens, lesions in the lower lobe, malignant lesions, and lesions measuring ≤ 1.0 cm or ≥ 3.1 cm significantly increased the rate of diagnostic failure.


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