Computed Tomography-Guided Transthoracic Needle Biopsy: Predictors for Diagnostic Failure and Tissue Adequacy for Molecular Testing

Abstract

Background: Adequate and representative tissue from lung tumor is important in the era of precision medicine. The aim of this study is to identify detailed procedure-related variables and factors influencing diagnostic success and tissue adequacy for molecular testing in CT-guided TTNB. Methods: Consecutive patients undergoing CT-guided TTNB were retrospectively enrolled between January 2013 and May 2020. Multivariate analysis was performed for predictors for diagnostic accuracy and tissue adequacy for molecular testing. Logistic regression was used to identify risk factors for procedure-related complications. Results: A total of 2,556 patients undergoing CT-guided TTNB were enrolled and overall success rate was 91.5% (2,338/2,556). For lung nodules ≤3 cm, predictors for diagnostic success included coaxial needle use [OR = 0.34 (0.16-0.71), p = 0.004], CT scan slice thickness of 2.5 mm [OR = 0.42 (0.15-0.82), p = 0.011] and additional prefire imaging [OR = 0.31 (0.14-0.68), p = 0.004]. For lung tumor >3 cm, ground glass opacity part more than 50% [OR = 7.53 (2.81-20.23), p < 0.001] or presence of obstructive pneumonitis [OR = 2.31 (1.53-3.48), p < 0.001] had higher risk of diagnostic failure. For tissue adequacy, tissue submitted in two cassettes (98.9 vs. 94.9%, p = 0.027) was a positive predictor; while male (5.7 vs. 2.5%, p = 0.032), younger age (56.61 ± 11.64 vs. 65.82 ± 11.98, p < 0.001), and screening for clinical trial (18.5 vs. 0.7%, p < 0.001) were negative predictors. Conclusions: Using a coaxial needle, with thin CT slice thickness (2.5 mm), and obtaining additional prefire imaging improved diagnostic success, while obtaining more than two tissue cores and submitting in two cassettes improved tissue adequacy for molecular testing.

Keywords: lung neoplasm; molecular testing; pathology; percutaneous CT-guided transthoracic biopsy; sensitivity and specificity.

Figure 1

Flow diagram of patient selection.

Figure 2

The rate of inadequate tissue during the study period. There was an evident increasing rate of rebiopsy since June 2017 because of expanding molecular analyses and clinical trials. Patients diagnosed with malignancy via TTNB between June 2017 and May 2020 were defined as cohort 2 to further assess predictors for tissue adequacy.

Figure 3

Representative example of additional prefire imaging with schematic illustration in a patient who had colon cancer undergoing CT-guided TTNB for 1.3 cm RLL lung nodule. Before biopsy gun was fired, appropriate specimen notch position (i.e., within the lesion) was confirmed. The pathology result revealed metastasis.