CT-guided percutaneous core needle biopsy for small (≤20 mm) pulmonary lesions

To assess the accuracy and risk factors for complications of computed tomography (CT)-guided percutaneous core needle biopsy (CNB) for small (≤20 mm) pulmonary lesions.

A retrospective study was undertaken comprising 169 patients who underwent CT-guided CNB for small (≤20 mm) pulmonary lesions. To assess the accuracy of the procedure, the diagnosis at biopsy was compared with the diagnosis after definitive surgery or clinical follow-up. The risk factors for pneumothorax and bleeding were determined by multivariate analysis of variables.

The overall diagnostic accuracy was 93.5%. The sensitivity for malignancy and specificity for benign lesions were 90.4% and 100%, respectively. Positive and negative predictive values were 100% and 83.3%, respectively. Twenty-five patients (14.8%) had pneumothorax after CT percutaneous CNB of the lung. The significant risk factors affecting the incidence of pneumothorax were lesion-pleural distance (p = 0.008) and needle-pleural angle (p = 0.012). The highest rate of pneumothorax correlated with a lesion-pleural distance ≥21 mm (OR = 18.46; 95%CI: 2.27-149.95) and a needle-pleural angle ≥51° (OR = 8.22; 95%CI: 2.14-31.49). Bleeding occurred in 30 patients (17.8%). The only significant risk factor affecting the incidence of bleeding was lesion-pleural distance (p = 0.011). The highest bleeding rate correlated with a lesion-pleural distance ≥21 mm (OR = 7.93; 95%CI: 1.73-36.43).

CT-guided percutaneous CNB of small (≤20 mm) pulmonary lesions provides high diagnostic accuracy with acceptable complications. A lesion-pleural distance of ≥21 mm and needle-pleural angle of ≥51° are identified as the risk factors for highest pneumothorax rate. In addition, the needle-pleural angle is a novel predictor of pneumothorax. A lesion-pleural distance of ≥21 mm is also identified as a risk factor for the highest bleeding rate.