Safety and diagnostic accuracy of percutaneous CT-guided transthoracic biopsy of small lung nodules (≤20 mm) adjacent to the pericardium or great vessels

Abstract

Purpose: We aimed to evaluate the safety and diagnostic accuracy of computed tomography (CT)-guided transthoracic biopsy of small lung nodules (≤20 mm) adjacent to the pericardium or great vessels.

Methods: This retrospective study examined the safety and diagnostic accuracy of percutaneous CT-guided biopsy for small lung nodules (≤20 mm) located within 10 mm of the pericardium or great vessels. Technical aspects and factors influencing complications were assessed, and diagnostic accuracy was calculated.

Results: A total of 168 biopsies were performed in 168 patients. The complications were mainly pneumothorax (34.5%; 58 of 168 patients), chest tube insertion (5.3%; 9 of 168 patients), and pulmonary hemorrhage (61.3%; 103 of 168 procedures), with no patient mortality. One patient (0.6%) was admitted because of hemorrhage complications. Significant independent risk factors for pneumothorax were nodules resided in upper or middle lobes and lateral patient position, and for hemorrhage, longer distance from structures and longer needle trajectory through the lung parenchyma. Overall, the sensitivity, accuracy, and specificity were 91.0%, 92.2%, and 100%, respectively.

Conclusion: Percutaneous CT-guided transthoracic biopsy was highly accurate in small lung nodules (≤20 mm) adjacent to the pericardium or great vessels. Complications are common, but most were minor and self-limited.

Figure 1

Flow diagram of patient management, interventions, and sample size for analyses.

Figure 2. a–d

Representative CT images show lung nodules located within 10 mm of left atrium (a), left ventricle (b), right atrium (c), and right ventricle (d).

Figure 3. a–h

Representative CT images show lung nodules located within 10 mm of aorta (a), innominate artery (b), pulmonary artery shunt (c), subclavian artery (d), superior vena cava (e), inferior vena cava (f), innominate vein (g), and subclavian vein (h).

Figure 4. a–c

CT-guided core biopsy of a small nodule in a 58-year-old woman. CT image (a) obtained before biopsy with patient in supine position shows a 17 mm lung nodule in the right lower lobe. The nodule is within 10 mm of the right atrium. CT image (b) obtained after needle placement shows the precise localization of the tip of the biopsy needle in the nodule. The length of needle trajectory through the lung parenchyma is 100 mm. CT image (c) obtained after needle removal shows grade 2 hemorrhage along the needle tract. The core biopsy diagnosis was adenocarcinoma, which was the final diagnosis after surgical resection.