[Punch biopsy or fine needle aspiration biopsy in percutaneous lung puncture?]

The diagnostic accuracy and rate of complications of CT-guided core biopsies (CB) from suspected tumors of the chest were compared to the accuracy a complications of fine-needle aspiration biopsies (FNAB).

The accuracy in the diagnosis of a benign or malignant lesion of 79 FNAB (19.5 G self-aspirating cutting needle) and of 83 CB (18 G automated core biopsy) and the rates of pneumothorax, pleural drainage and hemoptysis were retrospectively evaluated.

With FNAB, the sensitivity for malignant lesions was 62.1% and the accuracy 68.4%. With CB the sensitivity amounted to 85.9% and accuracy to 86.7%. The rate of pneumothorax was 25.3% following FNAB, with a drainage rate of 5.1% compared to 19.3% and 6.0%, respectively, following CB. The rate of pneumothorax and drainage increased with increasing path length through aerated lung. In advanced emphysema, the pneumothorax rate did not increase; however, in pneumothoraces, pleural drainage was mandatory in 20% of FNAB and in 100% of CB. Hemoptysis without any therapeutic consequences occurred in 3.8% following FNAB and in 6.0% following CB.

With CB diagnostic accuracy can be clearly increased without an obvious increase in the complication rate. However, in patients with obvious emphysema, the pleural drainage rate of pneumothorax may be higher following CB.