Transthoracic needle biopsy of small pulmonary nodules

To evaluate the diagnostic accuracy, complications, and usefulness of transthoracic needle biopsy of small pulmonary nodules.

Between January 1993 and January 1995, 302 patients underwent transthoracic needle biopsy of pulmonary lesions. Sixty-four lesions (in 62 patients) represented small nodules, defined as lesions of 15 mm or less maximum diameter. A total of 75 biopsies were performed in the 64 lesions. Approximately 90% of the biopsies were performed with computed tomographic guidance.

There were 21 benign lesions and 43 cancers (36 primary, seven metastatic). Transthoracic needle biopsy findings were positive for cancer in 40 cases. In all three false-negative lesions, only one biopsy was performed. There were 21 true-negative results and no false-positive results. Positive and negative predictive values were 100% and 88%, respectively. Pneumothorax occurred in 20 (27%) of 75 biopsies, but chest tube placement was necessary in only three cases (4%). Surgery or thoracoscopy was avoided in 31 patients: 17 of 20 patients with benign disease, seven patients with metastatic disease, and seven patients with inoperable lung cancer.

Transthoracic needle biopsy of small pulmonary nodules can produce diagnostic yields comparable with published results of transthoracic needle biopsy of larger lesions.