Korean J Radiol.  2017 Dec;18(6):1005-1011. 10.3348/kjr.2017.18.6.1005.

Practice Pattern of Transthoracic Needle Biopsy: 2016 Survey in the Members of Korean Society of Thoracic Radiology

• Jo Y
• Han DH
• Beck KS
• Park JS
• Kim TJ

• KMID: 2427210
• DOI: http://doi.org/10.3348/kjr.2017.18.6.1005

Abstract

OBJECTIVE
To assess the current practice patterns of radiologists who perform transthoracic needle biopsy (TNB).
MATERIALS AND METHODS
An email survey of 71 questions on TNB was sent to 240 members of the Korean Society of Thoracic Radiology. The answers to multiple-choice questions (n = 56) were analyzed.
RESULTS
Of 60 respondents, 45% had 10 or more years of experience in chest radiology, and 70% had 5 or more years of experience in TNB. For the question on the most frequently used diagnostic method for lesions with high probability of being resectable-stage lung cancer, 70% of respondents answered that TNB is initially used, with or without bronchoscopy. In patients at high-risk of TNB-related complications, the proportion of the respondents who consistently declined TNB was only 5%. The number of rebiopsies was said to be increased; molecular analysis for an established target therapy (43.6%) and clinical trial of a new drug (28.2%) were the two most common reasons for it. The most popular needle type was the coaxial cutting needle (55%), and the popular guiding modality was conventional computed tomography (CT) (56.7%). In addition, 15% of respondents have encountered air embolism.
CONCLUSION
Despite high variation in how TNB is being performed in Korea, some patterns were noted. It is common for patients with resectable-stage lung cancer to undergo TNB prior to surgery. Rebiopsy is now more common than before, with personalized medicine as the most important reason for it. The most popular type of needle is the coaxial system; the most popular modality for guidance is still CT.

Keyword

Lung biopsy; Core biopsy; Tumor; Malignancy; Method; Technique; Preference; Image-guided; CT-guided; Fluoroscopy-guided; Robotic arm; Precision medicine; Mutation

MeSH Terms

Adult
Aged
Biopsy, Needle/adverse effects/*methods
Bronchoscopy
Female
Hemorrhage/etiology
Humans
Lung/diagnostic imaging/*pathology
Lung Diseases/*diagnosis/pathology
Lung Neoplasms/diagnosis/pathology
Middle Aged
Radiography, Thoracic
Republic of Korea
Societies, Medical
Surveys and Questionnaires
Tomography, X-Ray Computed

Reference

1. Goralnik CH, O’Connell DM, el Yousef SJ, Haaga JR. CT-guided cutting-needle biopsies of selected chest lesions. AJR Am J Roentgenol. 1988; 151:903–907.

2. Manhire A, Charig M, Clelland C, Gleeson F, Miller R, Moss H, et al. Guidelines for radiologically guided lung biopsy. Thorax. 2003; 58:920–936.

3. Wallace MJ, Krishnamurthy S, Broemeling LD, Gupta S, Ahrar K, Morello FA Jr, et al. CT-guided percutaneous fine-needle aspiration biopsy of small (< or =1-cm) pulmonary lesions. Radiology. 2002; 225:823–828.

4. Murphy JM, Gleeson FV, Flower CD. Percutaneous needle biopsy of the lung and its impact on patient management. World J Surg. 2001; 25:373–379.

5. Sheth S, Hamper UM, Stanley DB, Wheeler JH, Smith PA. US guidance for thoracic biopsy: a valuable alternative to CT. Radiology. 1999; 210:721–726.

6. Flower CD, Verney GI. Percutaneous needle biopsy of thoracic lesions--an evaluation of 300 biopsies. Clin Radiol. 1979; 30:215–218.

7. Greif J, Marmur S, Schwarz Y, Man A, Staroselsky AN. Percutaneous core cutting needle biopsy compared with fine-needle aspiration in the diagnosis of peripheral lung malignant lesions: results in 156 patients. Cancer. 1998; 84:144–147.

8. Wu CC, Maher MM, Shepard JA. Complications of CT-guided percutaneous needle biopsy of the chest: prevention and management. AJR Am J Roentgenol. 2011; 196:W678–W682.

9. Jin GY, Kim JS, Kwon KS. Percutaneous transthoracic needle biopsy of pulmonary lesions: a National Survey of Korean Practice. J Korean Radiol Soc. 2008; 59:311–316.

10. Richardson CM, Pointon KS, Manhire AR, Macfarlane JT. Percutaneous lung biopsies: a survey of UK practice based on 5444 biopsies. Br J Radiol. 2002; 75:731–735.

11. Lim KJ, Yoon DY, Yun EJ, Seo YL, Baek S, Gu DH, et al. Characteristics and trends of radiology research: a survey of original articles published in AJR and Radiology between 2001 and 2010. Radiology. 2012; 264:796–802.

12. Lee C, Guichet PL, Abtin F. Percutaneous lung biopsy in the molecular profiling era: a survey of current practices. J Thorac Imaging. 2017; 32:63–67.

13. Lalji UC, Wildberger JE, Zur Hausen A, Bendek M, Dingemans AM, Hochstenbag M, et al. CT-guided percutaneous transthoracic needle biopsies using 10G large-core needles: initial experience. Cardiovasc Intervent Radiol. 2015; 38:1603–1610.

14. Choi SH, Chae EJ, Shin SY, Kim EY, Kim JE, Lee HJ, et al. Comparisons of clinical outcomes in patients with and without a preoperative tissue diagnosis in the persistent malignant-looking, ground-glass-opacity nodules. Medicine (Baltimore). 2016; 95:e435.

15. Choi JW, Park CM, Goo JM, Park YK, Sung W, Lee HJ, et al. C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of small (≤ 20 mm) lung nodules: diagnostic accuracy and complications in 161 patients. AJR Am J Roentgenol. 2012; 199:W322–W330.

16. Rivera MP, Detterbeck F, Mehta AC. American College of Chest Physicians. Diagnosis of lung cancer: the guidelines. Chest. 2003; 123:1 Suppl. 129S–136S.

17. Nosaki K, Satouchi M, Kurata T, Yoshida T, Okamoto I, Katakami N, et al. Re-biopsy status among non-small cell lung cancer patients in Japan: a retrospective study. Lung Cancer. 2016; 101:1–8.

18. Lindeman NI, Cagle PT, Beasley MB, Chitale DA, Dacic S, Giaccone G, et al. Molecular testing guideline for selection of lung cancer patients for EGFR and ALK tyrosine kinase inhibitors: guideline from the College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology. Arch Pathol Lab Med. 2013; 137:828–860.

19. Nguyen KS, Neal J. Lung cancer. In : Singh AK, Loscalzo J, editors. The Brigham intensive review of internal medicine. 2nd ed. New York: Oxpord University Press;2014. p. 100.

20. Schneider F, Smith MA, Lane MC, Pantanowitz L, Dacic S, Ohori NP. Adequacy of core needle biopsy specimens and fine-needle aspirates for molecular testing of lung adenocarcinomas. Am J Clin Pathol. 2015; 143:193–200.

21. Eberhard DA, Giaccone G, Johnson BE. Non-Small-Cell Lung Cancer Working Group. Biomarkers of response to epidermal growth factor receptor inhibitors i Non-Small-Cell Lung Cancer Working Group: standardization for use in the clinical trial setting. J Clin Oncol. 2008; 26:983–994.

22. Yoon HJ, Lee HY, Lee KS, Choi YL, Ahn MJ, Park K, et al. Repeat biopsy for mutational analysis of non-small cell lung cancers resistant to previous chemotherapy: adequacy and complications. Radiology. 2012; 265:939–948.

23. Priola AM, Priola SM, Cataldi A, Ferrero B, Garofalo G, Errico L, et al. CT-guided percutaneous transthoracic biopsy in the diagnosis of mediastinal masses: evaluation of 73 procedures. Radiol Med. 2008; 113:3–15.

24. Collins CD, Breatnach E, Nath PH. Percutaneous needle biopsy of lung nodules following failed bronchoscopic biopsy. Eur J Radiol. 1992; 15:49–53.

25. Lim C, Lee KY, Kim YK, Ko JM, Han DH. CT-guided core biopsy of malignant lung lesions: how many needle passes are needed? J Med Imaging Radiat Oncol. 2013; 57:652–656.

26. Solomon SB, Zakowski MF, Pao W, Thornton RH, Ladanyi M, Kris MG, et al. Core needle lung biopsy specimens: adequacy for EGFR and KRAS mutational analysis. AJR Am J Roentgenol. 2010; 194:266–269.

27. Cheung YC, Chang JW, Hsieh JJ, Lin G, Tsai YH. Adequacy and complications of computed tomography-guided core needle biopsy on non-small cell lung cancers for epidermal growth factor receptor mutations demonstration: 18-gauge or 20-gauge biopsy needle. Lung Cancer. 2010; 67:166–169.

28. Sinner WN. Complications of percutaneous transthoracic needle aspiration biopsy. Acta Radiol Diagn (Stockh). 1976; 17:813–828.

29. Tomiyama N, Yasuhara Y, Nakajima Y, Adachi S, Arai Y, Kusumoto M, et al. CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol. 2006; 59:60–64.

30. Hiraki T, Fujiwara H, Sakurai J, Iguchi T, Gobara H, Tajiri N, et al. Nonfatal systemic air embolism complicating percutaneous CT-guided transthoracic needle biopsy: four cases from a single institution. Chest. 2007; 132:684–690.

31. Cianci P, Posin JP, Shimshak RR, Singzon J. Air embolism complicating percutaneous thin needle biopsy of lung. Chest. 1987; 92:749–751.

32. Mansour A, AbdelRaouf S, Qandeel M, Swaidan M. Acute coronary artery air embolism following CT-guided lung biopsy. Cardiovasc Intervent Radiol. 2005; 28:131–134.

33. Mokhlesi B, Ansaarie I, Bader M, Tareen M, Boatman J. Coronary artery air embolism complicating a CT-guided transthoracic needle biopsy of the lung. Chest. 2002; 121:993–996.

34. Tolly TL, Feldmeier JE, Czarnecki D. Air embolism complicating percutaneous lung biopsy. AJR Am J Roentgenol. 1988; 150:555–556.

35. Grage RA, Naveed MA, Keogh S, Wang D. Efficacy of a dehydrated hydrogel plug to reduce complications associated with computed tomography-guided percutaneous transthoracic needle biopsy. J Thorac Imaging. 2017; 32:57–62.