Ct-guided Percutaneous 20-gauge Core-needle Biopsy In Pulmonary Nodules ≤ 20 Mm: Technique And Factors Of Accuracy
Ricardo S. Santos1, Juliano R. Andrade1, Priscila Falsarella1, Antônio Rahal, Jr1, Juliana P. Franceschini2, Rodrigo Gobbo1.
1Hospital Israelita Albert Einstein, São Paulo, Brazil, 2Instituto Tórax, São Paulo, Brazil.
OBJECTIVE: Lung CT Screening has evolved allowing identification of a large number of small (≤ 20mm) pulmonary nodules. The main options for managing higher suspicious are follow-up CT at 3-12 months or histopathological evaluation. We evaluated the overall diagnostic accuracy of CT-guided percutaneous 20-gauge CNB for small pulmonary nodules and factors that may influence the accuracy.
METHODS: Single-center study with retrospective analysis from January 2010 to August 2015 with patients submitted to CT-guided percutaneous CNB of small pulmonary nodules (≤ 20mm). The institution’s ethics committee approved this study. A multi-slice CT scanner (Somatom Definition AS 40-slice, Siemens) guided all biopsies.
RESULTS: 156 biopsies were performed with an overall diagnostic accuracy of 92.3%. Among conclusive biopsies, 101 were malignant and 43 were benign. Larger lesions were associated with high overall accuracy, while parenchymal haemorrhage during the procedure had lower accuracy rates. Surgical resection was performed in 46 patients; 42 of those were malignant lesions. Pneumothorax was the most common complication. In the multivariate analysis, lesion-pleural distance > 30 mm was identified as a risk factor for pneumothorax (OR = 16.94, 95% CI; 2.39-120.26); while performing blood patch in the needle track after the biopsy was associated as a protective factor for pneumothorax (OR = 0.18 95% CI; 0.04-0.86). In terms of bleeding complications related to the procedure, alveolar haemorrhage occurred in 15 biopsies (9.6%), which was mild in ten and moderate in five. There was also one case of mild hemothorax.
CONCLUSIONS: CT-guided percutaneous 20-gauge CNB of pulmonary lesions ≤ 20mm yields high overall accuracy. The variables associated with lower accuracy were lesion size and presence of parenchymal haemorrhage. Blood patch technique reduced overall morbidity.
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