Clinical utility of image-guided chest wall mass biopsy: results in 28 patients

The purpose of our study was to determine the clinical usefulness of percutaneous image-guided biopsy of chest wall masses. A retrospective study of 28 patients who underwent image-guided biopsy of chest wall masses from 2005 to 2007 was performed. In 19 (68%) patients, the mass was detected as part of a staging evaluation in patients with known malignancy; 9 (32%) patients had no known malignancy. Biopsy results were classified as diagnostic (malignant or benign) or non-diagnostic (atypical and insufficient). Sensitivity, specificity and negative predictive value were calculated for all patients, and the Fisher-Freeman-Halton exact test was used to determine if test characteristics varied in patients with and without a history of cancer, masses smaller and greater than 5 cm, or according to needle size. The overall diagnostic rate was 71%. Of these, there were 20 true-positives, 3 true-negatives, 5 false-negatives and no false-positive results (sensitivity 80% (20/25), specificity 100% (3/3) and negative predictive value 37.5% (3/8)). There were no differences between patients with and without cancer. Among 19 patients with known cancer, 10 had metastatic disease from their known primary. Biopsy test characteristics did not differ with respect to mass or needle size. Minor complications were seen in 7% of patients. Image-guided chest wall mass biopsy is a sensitive and specific procedure, which is clinically important in the care of patients both with and without a known primary cancer.