Clinical application of CT and CT-guided percutaneous transthoracic needle biopsy in patients with indeterminate pulmonary nodules

Abstract

Objective: To investigate the clinical application of CT and CT-guided percutaneous transthoracic needle biopsy (CT-PTNB) in patients with indeterminate pulmonary nodules (IPNs).

Methods: We retrospectively studied 113 patients with PNs undergoing CT and CT-PTNB. Variables such as gender, age at diagnosis, smoking status, CT findings, and CT-PTNB techniques were analyzed. Data analysis was performed with the Student's t-test for independent samples the chi-square test, and normal approximation test for comparison of two proportions.

Results: Of the 113 patients studied, 68 (60.2%) were male and 78 (69%) were smokers. The diameter of malignant lesions ranged from 2.6 cm to 10.0 cm. Most of the IPNs (85%) were located in the peripheral region. The biopsied IPNs were found to be malignant in 88 patients (77.8%) and benign in 25 (22.2%). Adenocarcinoma was the most common malignant tumor, affecting older patients. The IPN diameter was significantly greater in patients with malignant PNs than in those with benign IPNs (p < 0.001). Having regular contour correlated significantly with an IPN being benign (p = 0.022), whereas spiculated IPNs and bosselated IPNs were more often malignant (in 50.7% and 28.7%, respectively). Homogeneous attenuation and necrosis were more common in patients with malignant lesions (51.9% and 26.9%, respectively)

Conclusions: In our sample, CT and CT-PTNB were useful in distinguishing between malignant and benign IPNs. Advanced age and smoking were significantly associated with malignancy. Certain CT findings related to IPNs (larger diameter, spiculated borders, homogeneous attenuation, and necrosis) were associated with malignancy.

Figure 1. Helical CT scans showing an irregular lung mass (in A; male patient, 77 years old), a bosselated lung mass (in B; male patient, 30 years old), a spiculated lung mass (in C; male patient, 64 years old), and a regular lung mass (in D; male patient, 36 years old)

Figure 2. Helical CT scans showing intralesional changes, including homogeneous attenuation (in A; male patient, 49 years old), necrosis (in B; male patient, 36 years old), calcification (in C; male patient, 56 years old), and air bronchogram (in D; male patient, 77 years old).

Figura 1. Cortes de TC helicoidal mostrando contornos de massa pulmonar irregular (em A; paciente masculino, 77 anos) e dos tipos bocelado (em B; paciente masculino, 30 anos), espiculado (em C; paciente masculino, 64 anos) e regular (em D; paciente masculino, 36 anos).

Figura 2. Cortes de TC helicoidal mostrando alterações intralesionais com aspecto homogêneo (em A; paciente masculino, 49 anos), necrose (em B; paciente masculino, 36 anos), calcificação (em C; paciente masculino, 56 anos) e broncograma aéreo (em D; paciente masculino, 77 anos).