Small (≤2-cm) Subpleural Pulmonary Lesions: Short- versus Long-Needle-Path CT-guided Biopsy—Comparison of Diagnostic Yields and Complications
Abstract
PURPOSE: To retrospectively compare the diagnostic yield and complications associated with the use of short versus long needle paths for computed tomography (CT)-guided biopsy of small subpleural lung lesions.
MATERIALS AND METHODS: The study was approved by the institutional review board, and the requirement for informed patient consent was waived. The medical and imaging records of patients who underwent CT-guided biopsy of subpleural pulmonary nodules measuring up to 2 cm in diameter were reviewed. The study included 176 patients (79 men, 97 women; age range, 18–84 years) who were divided into two groups: In group A, a direct approach in which the needle traversed a short lung segment was used. In group B, an indirect approach involving the use of a longer needle path was used. Diagnostic yield, accuracy, and pneumothorax and chest tube placement rates were compared between the two groups. Two-tailed t tests and Pearson χ2 tests were used to analyze continuous and categorized variables, respectively.
RESULTS: Group A comprised 48 patients; and group B, 128 patients. The mean needle path length was 0.4 cm in group A and 5.6 cm in group B. The short-path approach necessitated more needle punctures (mean, 2.9 vs 1.8 with long-path approach, P < .001) through the pleura. The diagnostic yield in group A was significantly lower than that in group B (71% vs 94%, P < .001), particularly in patients with small (0–1-cm) nodules (40% in group A vs 94% in group B, P < .001). The frequency of postbiopsy pneumothorax was identical (69%) in the two groups. However, more group B than group A patients required chest tube placement for treatment of pneumothorax (38% vs 17%, P = .006).
CONCLUSION: Use of long-needle-path biopsy of subpleural lesions resulted in a higher diagnostic yield, especially for small nodules. However, compared with the short-needle-path technique, this approach was associated with a higher frequency of chest tube placement for pneumothorax.
© RSNA, 2005
References
- 1 Westcott JL. Percutaneous transthoracic needle biopsy. Radiology 1988; 169:593-601.
- 2 Swischuk JL, Castaneda F, Patel JC, et al. Percutaneous transthoracic needle biopsy of the lung: review of 612 lesions. J Vasc Interv Radiol 1998; 9:347-352.
- 3 Westcott JL, Rao N, Colley DP. Transthoracic needle biopsy of small pulmonary nodules. Radiology 1997; 202:97-103.
- 4 Laurent F, Latrabe V, Vergier B, Montaudon M, Vernejoux JM, Dubrez J. CT-guided transthoracic needle biopsy of pulmonary nodules smaller than 20 mm: results with an automated 20-gauge coaxial cutting needle. Clin Radiol 2000; 55:281-287.
- 5 Klein JS, Zarka MA. Transthoracic needle biopsy: an overview. J Thorac Imaging 1997; 12:232-249.
- 6 Klein JS, Salomon G, Stewart EA. Transthoracic needle biopsy with a coaxially placed 20-gauge automated cutting needle: results in 122 patients. Radiology 1996; 198:715-720.
- 7 Tsukada H, Satou T, Iwashima A, Souma T. Diagnostic accuracy of CT-guided automated needle biopsy of lung nodules. AJR Am J Roentgenol 2000; 175:239-243.
- 8 Tanaka J, Sonomura T, Shioyama Y, et al. “Oblique path”: the optimal needle path for computed tomography-guided biopsy of small subpleural lesions. Cardiovasc Intervent Radiol 1996; 19:332-334.
- 9 Wallace MJ, Krishnamurthy S, Broemeling LD, et al. CT-guided percutaneous fine-needle aspiration biopsy of small (≤1-cm) pulmonary lesions. Radiology 2002; 225:823-828.
- 10 Gatenby RA, Mulhern CB, Jr, Broder GJ, Moldofsky PJ. Computed-tomographic-guided biopsy of small apical and peripheral upper-lobe lung masses. Radiology 1984; 150:591-592.
- 11 Moore EH. Technical aspects of needle aspiration lung biopsy: a personal perspective. Radiology 1998; 208:303-318.
- 12 Yeow KM, See LC, Lui KW, et al. Risk factors for pneumothorax and bleeding after CT-guided percutaneous coaxial cutting needle biopsy of lung lesions. J Vasc Interv Radiol 2001; 12:1305-1312.
- 13 Li H, Boiselle PM, Shepard JO, Trotman-Dickenson B, McLoud TC. Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules. AJR Am J Roentgenol 1996; 167:105-109.
- 14 Katada K, Kato R, Anno H, et al. Guidance with real-time CT fluoroscopy: early clinical experience. Radiology 1996; 200:851-856.
- 15 Irie T, Kajitani M, Matsueda K, et al. Biopsy of lung nodules with use of I-I device under intermittent CT fluoroscopic guidance: preliminary clinical study. J Vasc Interv Radiol 2001; 12:215-219.
- 16 Cox JE, Chiles C, McManus CM, Aquino SL, Choplin RH. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Radiology 1999; 212:165-168.
- 17 Poe RH, Kallay MC, Wicks CM, Odoroff CL. Predicting risk of pneumothorax in needle biopsy of the lung. Chest 1984; 85:232-235.
- 18 Fish GD, Stanley JH, Miller KS, Schabel SI, Sutherland SE. Postbiopsy pneumothorax: estimating the risk by chest radiography and pulmonary function tests. AJR Am J Roentgenol 1988; 150:71-74.
- 19 Miller KS, Fish GB, Stanley JH, Schabel SI. Prediction of pneumothorax rate in percutaneous needle aspiration of the lung. Chest 1988; 93:742-745.
- 20 Kazerooni EA, Lim FT, Mikhail A, Martinez FJ. Risk of pneumothorax in CT-guided transthoracic needle aspiration biopsy of the lung. Radiology 1996; 198:371-375.
- 21 Ohno Y, Hatabu H, Takenaka D, et al. CT-guided transthoracic needle aspiration biopsy of small (< or = 20 mm) solitary pulmonary nodules. AJR Am J Roentgenol 2003; 180:1665-1669.
- 22 Moulton JS, Moore PT. Coaxial percutaneous biopsy technique with automated biopsy devices: value in improving accuracy and negative predictive value. Radiology 1993; 186:515-522.
- 23 vanSonnenberg E, Casola G, Ho M, et al. Difficult thoracic lesions: CT-guided biopsy experience in 150 cases. Radiology 1988; 167:457-461.
