Safety and diagnostic accuracy of image-guided transthoracic core needle biopsy in pediatric patients

Image-guided transthoracic core needle biopsy (CNB) is a minimally invasive method widely used for diagnosing thoracic lesions. While its effectiveness and safety are well established in adults, data on its performance in pediatric populations are limited, necessitating further evaluation. This study aimed to assess the efficacy, diagnostic performance, and safety of image-guided transthoracic CNB in children with thoracic lesions.

A retrospective study was conducted on 40 pediatric patients who underwent image-guided transthoracic CNB between May 2011 and January 2025. Biopsies were performed under ultrasound (US) or computed tomography (CT) guidance, depending on lesion location. Demographics, lesion characteristics, imaging modality, histopathology, and complications were analyzed.

Technical success was 100%. Diagnostic accuracy was 95%, with a sensitivity of 95.2%, specificity of 100%, PPV of 100%, and NPV of 94.7%. CT was used for central intraparenchymal lung lesions (n = 11); US was used for mediastinal (n = 8), pleural (n = 9), and peripheral lung lesions (n = 12). Pneumothorax occurred in 18.2% (2/11) of CT-guided cases and 6.9% (2/29) of US-guided cases. One chest tube was required (3.4%). Pulmonary hemorrhage occurred in one CT-guided case (9.1%). There was no statistically significant difference in complication rates between the CT-guided and US-guided biopsy groups (p = 0.300).

Image-guided transthoracic CNB is a safe and reliable diagnostic technique for thoracic lesions in pediatric patients, offering high diagnostic accuracy with low complication rates.