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Difficult thoracic lesions: CT-guided biopsy experience in 150 cases.
E vanSonnenberg1, G Casola, M Ho
1Department of Radiology, University of California San Diego Medical Center 92013.
Radiology
|May 1, 1988
Summary
Computed tomography (CT) guided percutaneous biopsy improved diagnosis rates for difficult thoracic lesions, even after non-diagnostic procedures. This technique expands options for diagnosing small, poorly visualized, or inaccessible pulmonary, mediastinal, and pleural abnormalities.
Area of Science:
- Thoracic Imaging
- Interventional Pulmonology
- Diagnostic Cytopathology
Background:
- Percutaneous biopsy is crucial for diagnosing thoracic lesions.
- Conventional methods like bronchoscopy and fluoroscopic biopsy can be limited in efficacy for certain lesions.
- Computed tomography (CT) offers advanced visualization for guiding interventions.
Purpose of the Study:
- To evaluate the diagnostic yield and safety of CT-guided percutaneous fine-needle biopsy for challenging thoracic lesions.
- To assess the utility of CT guidance in cases with prior non-diagnostic procedures.
- To determine the range of thoracic lesions amenable to CT-guided biopsy.
Main Methods:
- A retrospective analysis of 150 patients undergoing CT-guided percutaneous fine-needle biopsy for thoracic lesions.
- Inclusion criteria focused on lesions that were small, juxta-vascular, poorly visualized, or considered inaccessible.
- Previous non-diagnostic bronchoscopy (62 cases) or fluoroscopic biopsy (14 cases) were noted.
Main Results:
- A diagnostic yield of 82.7% (124/150 cases) was achieved.
- High diagnostic rates were observed for lung nodules (80.4%), mediastinal lesions (90.3%), and pleural masses (83.3%).
- Complications included pneumothorax (64 cases), hemoptysis (5 cases), hemothorax (2 cases), and pericarditis (1 case).
Conclusions:
- CT-guided percutaneous fine-needle biopsy is an effective method for diagnosing difficult thoracic lesions, significantly increasing diagnostic yield.
- The technique is particularly valuable for lesions not visualized on conventional radiography or those previously biopsied unsuccessfully.
- While pneumothorax is a common complication, CT guidance facilitates immediate radiologic management, expanding the scope of percutaneous thoracic biopsy.