CT-guided transthoracic needle biopsy of pulmonary lesions: comparison between the cutting needle and aspiration...

To compare CT-guided transthoracic cutting needle biopsy (TCNB) with transthoracic aspiration needle biopsy (TANB) for pulmonary lesions with respect to the diagnostic accuracy and complication rate.

Of the 859 cases that underwent consecutive CT-guided biopsy of pulmonary lesions, 713 cases confirmed by surgical pathology or clinical follow-up were enrolled. Of these, the first consecutive 275 cases underwent TANB, and the remaining 438 received TCNB. The final diagnosis determined the accuracy of biopsy. Based on the post-biopsy CT and clinical medical records, the presence or absence of biopsy-related complications was determined. The χ² test was used to compare the differences between TCNB and TANB in terms of diagnostic accuracy and complication rate.

Among the 713 biopsy lesions, the final diagnosis was malignant in 411 cases and benign in 302 cases. As compared to TANB, the diagnostic accuracy of TCNB (98.9% vs 93.8%, χ² = 14.35, p < 0.01), sensitivity to malignant lesions (97.8% vs 90.6%, χ² = 10.58, p < 0.01), negative predictive value (97.6% vs 84.8%, χ² = 19.03, p < 0.01), and specific diagnostic rate for benign lesions (73.4% vs 57.9%, χ² = 7.29, p < 0.01) were improved. On the other hand, a statistical difference was detected between TCNB and TANB with respect to the incidence of pneumothorax (20.6% vs 13.1%, χ² = 6.46, p = 0.01), hemorrhage (32.2% vs 13.1%, χ² = 33.03, p < 0.01), and hemoptysis (8.2% vs 3.3%, χ² = 6.87, p < 0.01). One patient died just several minutes after TCNB due to severe hemorrhage with hemoptysis.

Compared to TANB, CT-guided TCNB improves the diagnostic accuracy of pulmonary lesions, but complication rate increases significantly.

In general, TCNB should be recommended, especially for highly suspicious benign lesions. For patients with small lesions adjacent to vessels or vessels within the lesion, TANB should be considered.