Clinical role, safety and diagnostic accuracy of percutaneous transthoracic needle biopsy in the evaluation of pulmonary consolidation

Abstract

Background: To determine the clinical role, safety, and diagnostic accuracy of percutaneous transthoracic needle biopsy in the evaluation of pulmonary consolidation.

Methods: A retrospective review of all computed tomography (CT)-guided percutaneous transthoracic needle biopsies (PTNB) at a tertiary care hospital over a 4-year period was performed to identify all cases of PTNB performed for pulmonary consolidation. For each case, CT Chest images were reviewed by two thoracic radiologists. Histopathologic and microbiologic results were obtained and clinical follow-up was performed.

Results: Thirty of 1090 (M:F 17:30, mean age 67 years) patients underwent PTNB for pulmonary consolidation (2.8% of all biopsies). A final diagnosis was confirmed in 29 patients through surgical resection, microbiology, or clinicoradiologic follow-up for at least 18 months after biopsy. PTNB had an overall diagnostic accuracy of 83%. A final diagnosis of malignancy was made in 20/29 patients, of which 19 were correctly diagnosed by PTNB, resulting in a sensitivity of 95% and specificity of 100% for malignancy. In all cases of primary lung cancer, adequate tissue for molecular testing was obtained. A benign final diagnosis was made in 9 patients, infection in 5 cases and non-infectious benign etiology in 4 cases. PTNB correctly diagnosed all cases of infection. Minor complications occurred in 13% (4/30) of patients.

Conclusions: Pulmonary consolidation can be safely evaluated with CT-guided percutaneous needle biopsy. Diagnostic yield is high, especially for malignancy. PTNB of pulmonary consolidation should be considered following non-diagnostic bronchoscopy.

Keywords: Consolidation; Hemoptysis; Percutaneous transthoracic needle biopsy; Pneumothorax.

Fig. 1

a) Axial CT scan in a 69-year-old man status post kidney transplant demonstrates an area of consolidation and surrounding ground glass opacity in the right middle and lower lobe. He underwent bronchoalveolar lavage and transbronchial biopsy which found acute hemorrhage and hemosiderosis. b) Axial CT scan obtained during PTNB, performed 2 days after bronchoscopy, shows the needle within the consolidation in the right middle lobe. Fungal hyphae were identified on cytologic evaluation and aspergillus was identified on accompanying microbiology culture. c) Axial CT performed three months later, on treatment with ambisome, shows the area of consolidation improving

Fig. 2

a) Axial CT scan in a 74-year-old woman demonstrates consolidation and ground glass opacity in the left lower lobe. b) Axial CT scan performed 3 months later demonstrates persistent consolidation and increased ground glass opacity in the left lower lobe. She underwent bronchoalveolar lavage and transbronchial biopsy which found bronchial columnar cells and macrophages but no evidence of malignancy. c) Axial CT scan obtained during PTNB, performed 4 weeks after the bronchoscopy shows the needle within the consolidation in the left lower lobe. Well-differentiated lung adenocarcinoma was confirmed on histology