0
Correspondence |

Diagnostic Performance of Percutaneous Core-Needle Lung Biopsy Under CT Scan Fluoroscopic Guidance for Pulmonary Lesions Measuring ≤10 mmNeedle Lung Biopsy Was Better for Smaller Lesions FREE TO VIEW

Yoshikane Yamauchi, MD; Yotaro Izumi, MD, PhD; Seishi Nakatsuka, MD, PhD; Masanori Inoue, MD; Yuichiro Hayashi, MD; Mitsutomo Kohno, MD, PhD; Takashi Ohtsuka, MD, PhD; Masaki Anraku, MD; Taichiro Goto, MD, PhD; Hiroaki Nomori, MD, PhD
Author and Funding Information

From the Division of General Thoracic Surgery, Department of Surgery (Drs Yamauchi, Izumi, Kohno, Ohtsuka, Anraku, Goto, and Nomori), the Department of Diagnostic Radiology (Drs Nakatsuka and Inoue), and the Division of Diagnostic Pathology (Dr Hayashi), School of Medicine, Keio University.

Correspondence to: Yotaro Izumi, MD, PhD, Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; e-mail: yotaroizumi@a2.keio.jp

FN = false negative; TN = true negative; TP = true positive.

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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

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


Chest. 2011;140(6):1669-1670. doi:10.1378/chest.11-1821
Text Size: A A A
Published online

To the Editor:

We know of two previous reports that have focused on the diagnostic performance of CT scan-guided fine-needle aspiration biopsy of pulmonary lesions measuring ≤10 mm.1,2 To our knowledge, however, the diagnostic accuracy of CT scan fluoroscopy-guided core-needle biopsy (Fig 1) for pulmonary lesions measuring ≤10 mm has not been evaluated.

Figure Jump LinkFigure 1. A, The representative target lesion, which was 8.3 mm in diameter. B-D, Three-slice simultaneous CT scan fluoroscopy images taken during the biopsy procedure. C, The image shows the needle overlapping the lesion. B and D, These images also depict the lesion. The needle penetrated the lesion and an appropriate sample could be obtained. This lesion was lung adenocarcinoma.Grahic Jump Location

We retrospectively identified 73 patients who underwent percutaneous core-needle lung biopsy under CT scan fluoroscopic guidance for pulmonary lesions measuring ≤10 mm between October 2002 and June 2009. The biopsy specimen results as well as the final diagnoses were available in 50 of these patients, and the results were compared (one lesion per patient). The diagnostic performance was also compared according to the lesion size (≤8 mm [n =22] vs >8 mm [n =28]), the depth from the lung surface (≤25 mm [n =32] vs >25 mm [n =18]), and the length of the needle path (≤7 cm [n =35] vs >7 cm [n =15]). Finally, all 73 cases were reviewed for complications. The patients’ age, gender, lesion size, depth from the lung surface, and length of the needle path were as follows, respectively (range in parentheses): 62±12 years of age (34-81), 31 men and 36 women, 8.6±1.5 mm (4-10), 23±16 mm (0-76), and 64±21 mm (33-125). The overall sensitivity, specificity, and accuracy were 90%, 100%, and 94%, respectively (Table 1). The sensitivity and accuracy (Fisher exact test) were not significantly affected by the size of the lesions (≤8 mm, 91% and 95%; 9-10 mm, 89% and 93%; P=.86 and P=.70, respectively). The diagnostic sensitivity and accuracy were lower in the lesions deeper from the lung surface (0-25 mm, 100% and 100%; >25 mm, 79% and 83%; P=.06 and P=.017, respectively) and in lesions with the longer needle path (≤7 cm, 100% and 100%; >7 cm, 70% and 80%; P=.012 and P=.006, respectively). Eight patients (11%) developed pneumothoraces. One patient required manual aspiration, but the others resolved conservatively. Four patients (6%) experienced mild hemoptysis, which resolved conservatively for all of them. As of this report, there have been no suspected cases of needle tract disseminations.

Table Graphic Jump Location
Table 1 —Comparison of Core Needle Biopsy Results With the Final Diagnoses

FN = false negative; TN = true negative; TP = true positive.

The diagnostic sensitivity and accuracy in the present study were slightly higher than in the previous two reports that focused on pulmonary lesions measuring ≤10 mm,1,2 which were 82% and 68% in sensitivity and 88% and 79% in accuracy, respectively. We presume that the higher levels of sensitivity and accuracy were the result of the acquisition of core biopsy specimens with the use of three-slice simultaneous CT scan fluoroscopy imaging. The proportion of nondiagnostic results in the present study, two of 52 (4%), was also substantially lower in comparison with the previous two reports using fine-needle aspiration biopsy1,2 (23% and 18%, respectively).

Wallace MJ, Krishnamurthy S, Broemeling LD, et al. CT-guided percutaneous fine-needle aspiration biopsy of small (< or =1-cm) pulmonary lesions. Radiology. 2002;2253:823-828 [CrossRef] [PubMed]
 
Ng YL, Patsios D, Roberts H, et al. CT-guided percutaneous fine-needle aspiration biopsy of pulmonary nodules measuring 10 mm or less. Clin Radiol. 2008;633:272-277 [CrossRef] [PubMed]
 

Figures

Figure Jump LinkFigure 1. A, The representative target lesion, which was 8.3 mm in diameter. B-D, Three-slice simultaneous CT scan fluoroscopy images taken during the biopsy procedure. C, The image shows the needle overlapping the lesion. B and D, These images also depict the lesion. The needle penetrated the lesion and an appropriate sample could be obtained. This lesion was lung adenocarcinoma.Grahic Jump Location

Tables

Table Graphic Jump Location
Table 1 —Comparison of Core Needle Biopsy Results With the Final Diagnoses

FN = false negative; TN = true negative; TP = true positive.

References

Wallace MJ, Krishnamurthy S, Broemeling LD, et al. CT-guided percutaneous fine-needle aspiration biopsy of small (< or =1-cm) pulmonary lesions. Radiology. 2002;2253:823-828 [CrossRef] [PubMed]
 
Ng YL, Patsios D, Roberts H, et al. CT-guided percutaneous fine-needle aspiration biopsy of pulmonary nodules measuring 10 mm or less. Clin Radiol. 2008;633:272-277 [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543