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. 2018 Jul-Aug;44(4):307-314.
doi: 10.1590/S1806-37562017000000259.

CT-guided percutaneous core needle biopsy of pulmonary nodules smaller than 2 cm: technical aspects and factors influencing accuracy

[Article in English, Portuguese]
Juliano Ribeiro de Andrade  1 , Rafael Dahmer Rocha  1 , Priscila Mina Falsarella  1 , Antonio Rahal Junior  1 , Ricardo Sales Dos Santos  2 , Juliana Pereira Franceschini  3 , Hiran Chrishantha Fernando  4 , Rodrigo Gobbo Garcia  1
Affiliations

CT-guided percutaneous core needle biopsy of pulmonary nodules smaller than 2 cm: technical aspects and factors influencing accuracy

[Article in English, Portuguese]
Juliano Ribeiro de Andrade et al. J Bras Pneumol. 2018 Jul-Aug.

Abstract
in English, Portuguese

Objective: To evaluate the diagnostic accuracy of CT-guided percutaneous core needle biopsy (CT-CNB) of pulmonary nodules ≤ 2 cm, as well as to identify factors influencing the accuracy of the procedure and its morbidity.

Methods: This was a retrospective, single-center study of 170 consecutive patients undergoing CT-CNB of small pulmonary nodules (of ≤ 2 cm) between January of 2010 and August of 2015.

Results: A total of 156 CT-CNBs yielded a definitive diagnosis, the overall diagnostic accuracy being 92.3%. Larger lesions were associated with a higher overall accuracy (OR = 1.30; p = 0.007). Parenchymal hemorrhage occurring during the procedure led to lower accuracy rates (OR = 0.13; p = 0.022). Pneumothorax was the most common complication. A pleura-to-lesion distance > 3 cm was identified as a risk factor for pneumothorax (OR = 16.94), whereas performing a blood patch after biopsy was a protective factor for pneumothorax (OR = 0.18).

Conclusions: Small nodules (of < 2 cm) represent a technical challenge for diagnosis. CT-CNB is an excellent diagnostic tool, its accuracy being high.

Objetivo:: Avaliar a precisão diagnóstica da biópsia percutânea com agulha grossa, guiada por TC - doravante denominada BAG-TC - de nódulos pulmonares ≤ 2 cm, bem como identificar fatores que influenciam a precisão do procedimento e sua morbidade.

Métodos:: Estudo retrospectivo, realizado em um único centro, com 170 pacientes consecutivos submetidos a BAG-TC de nódulos pulmonares pequenos (≤ 2 cm) entre janeiro de 2010 e agosto de 2015.

Resultados:: Do total de biópsias, 156 resultaram em diagnóstico definitivo, com precisão diagnóstica global de 92,3%. Lesões maiores estiveram relacionadas com maior precisão global (OR = 1,30; p = 0,007). A presença de hemorragia parenquimatosa durante o procedimento resultou em menor precisão (OR = 0,13; p = 0,022). Pneumotórax foi a complicação mais comum. Uma distância &gt; 3 cm entre a lesão e a pleura foi identificada como fator de risco de pneumotórax (OR = 16,94), ao passo que a realização de tampão sanguíneo após a biópsia foi um fator de proteção contra o pneumotórax (OR = 0,18).

Conclusões:: O diagnóstico de nódulos pequenos (&lt; 2 cm) é um desafio do ponto de vista técnico. A BAG-TC é uma excelente ferramenta diagnóstica, cuja precisão é alta.

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Figures

Figure 1
Figure 1. Flow chart of 174 patients undergoing CT-guided percutaneous core needle biopsy of pulmonary nodules of ≤ 2 cm in size, together with the final diagnosis.
Figure 2
Figure 2. In A, pulmonary nodule with slightly jagged edges, measuring 0.6 cm and located in the lateral basal segment of the right lower lobe. In B, coaxial needle placement guided by CT. In C, alveolar hemorrhage after collection of the first specimen.
See this image and copyright information in PMC

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