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CT Fluoroscopy-Guided Biopsy of 1,000 Pulmonary Lesions Performed With 20-Gauge Coaxial Cutting Needles: Diagnostic Yield and Risk Factors for Diagnostic Failure.
Chest. 2009 May 8;
Authors: Hiraki T, Mimura H, Gobara H, Iguchi T, Fujiwara H, Sakurai J, Matsui Y, Inoue D, Toyooka S, Sano Y, Kanazawa S
Background Although conventional CT-guided needle biopsy is an established diagnostic method for pulmonary lesions, few large studies have been conducted on the diagnostic outcomes of CT fluoroscopy-guided lung biopsy. We have conducted a retrospective analysis to evaluate the diagnostic outcomes of 1000 CT fluoroscopy-guided lung biopsies performed with 20-gauge coaxial cutting needles. Methods We determined the diagnostic yield of CT fluoroscopy-guided lung biopsies performed with 20-gauge coaxial cutting needles for 1000 lesions in 901 patients. Independent risk factors for diagnostic failure (ie, nondiagnostic, false-positive, and false-negative results) were determined using multivariate logistic regression analysis. Results The biopsy results were nondiagnostic in 0.6% (6/1000) of the lesions. The sensitivity and specificity for the diagnosis of malignancy was 94.2% (741/787) and 99.1% (211/213), respectively; diagnostic accuracy was 95.2% (952/1000). For lesions measuring </= 1.0 cm, the diagnostic accuracy was 92.7% (140/151). The significant independent risk factors for diagnostic failure were as follows: the acquisition of </= 2 specimens (odds ratio [OR], 2.43; p = 0.007), lesions in the lower lobe (OR, 2.50; p = 0.003), malignant lesions (OR, 7.16; p = 0.007), and lesions measuring </= 1.0 cm (OR, 3.85; p = 0.016) and >/= 3.1 cm (OR, 4.32; p = 0.007). Conclusions CT fluoroscopy-guided lung biopsy performed with 20-gauge coaxial cutting needles resulted in a high diagnostic yield, even in the case of small lesions. Factors such as the acquisition of </= 2 specimens, lesions in the lower lobe, malignant lesions, and lesions measuring </= 1.0 cm or >/= 3.1 cm significantly increased the rate of diagnostic failure.
PMID: 19429718 [PubMed - as supplied by publisher]