A Multicenter Study on Unnecessary Rebiopsies in CT-Guided Percutaneous Transthoracic Needle Biopsy of Pulmonary...

Computed tomography-guided percutaneous transthoracic needle biopsy of pulmonary lesions (PTNBP) is widely used for diagnosing and managing lung cancer. However, rebiopsies are often required due to insufficient specimens for definitive pathological diagnosis and molecular testing, which increase patient burden and reduce treatment efficiency. This study aims to investigate the characteristics of rebiopsies and propose strategies to minimize unnecessary rebiopsies.

A total of 12,882 PTNBP cases from three centers were analyzed from January 2018 to December 2022. Attribution analysis was conducted for the rebiopsy cases, and descriptive analysis was conducted for clinical parameters.

The rebiopsy rate was 6.5% (841/12,882), with 31.0% (261/841) of rebiopsies due to insufficient specimens. Among these cases, 87.0% (227/261) were stage III-IV, 89.7% (234/261) had poorly differentiated tumors, and 80.1% (209/261) were non-small cell lung cancer (NSCLC). The proportion of molecular testing in stage IV cases was significantly higher than in stage I-III cases (44.8% vs. 25.3%, p = 0.0022). Poorly differentiated cases required significantly more biomarkers in immunohistochemistry and special staining than moderately and well-differentiated cases (8.1 vs. 4.0, p = 0.0039). Insufficient tissue rates were significantly higher in cases with only one biopsy core compared to those with more cores (2.4% vs. 1.5%, p = 0.0088).

Patients with advanced-stage disease, poorly differentiated tumors, and NSCLC undergoing PTNBP are more likely to require rebiopsy due to insufficient specimens. Increasing the number of biopsy cores (≥ 2) and implementing one-stop management for pathological assessment may effectively reduce unnecessary rebiopsies in PTNBP.