Korean J Radiol.  2019 Nov;20(11):1515-1526. 10.3348/kjr.2019.0014.

Non-Diagnostic CT-Guided Percutaneous Needle Biopsy of the Lung: Predictive Factors and Final Diagnoses

• Tongbai T
• McDermott
• Kiranantawat N
• Muse VV
• Wu CC
• Shepard JA
• Gilman MD

• KMID: 2459419
• DOI: http://doi.org/10.3348/kjr.2019.0014

Abstract

OBJECTIVE
To investigate the predictive factors for a non-diagnostic result and the final diagnosis of pulmonary lesions with an initial non-diagnostic result on CT-guided percutaneous transthoracic needle biopsy.
MATERIALS AND METHODS
All percutaneous transthoracic needle biopsies performed over a 4-year period were retrospectively reviewed. The initial pathological results were classified into three categories"”malignant, benign, and non-diagnostic. A non-diagnostic result was defined when no malignant cells were seen and a specific benign diagnosis could not be made. The demographic data of patients, lesions' characteristics, technique, complications, initial pathological results, and final diagnosis were reviewed. Statistical analysis was performed using binary logistic regression.
RESULTS
Of 894 biopsies in 861 patients (male:female, 398:463; mean age 67, range 18-92 years), 690 (77.2%) were positive for malignancy, 55 (6.2%) were specific benign, and 149 (16.7%) were non-diagnostic. Of the 149 non-diagnostic biopsies, excluding 27 cases in which the final diagnosis could not be confirmed, 36% revealed malignant lesions and 64% revealed benign lesions. Predictive factors for a non-diagnostic biopsy included the size ≤ 15 mm, needle tract traversing emphysematous lung parenchyma, introducer needle outside the lesion, procedure time > 60 minutes, and presence of alveolar hemorrhage. Non-diagnostic biopsies with a history of malignancy or atypical cells on pathology were more likely to be malignant (p = 0.043 and p = 0.001).
CONCLUSION
The predictive factors for a non-diagnostic biopsy were lesion size ≤ 15 mm, needle tract traversing emphysema, introducer needle outside the lesion, procedure time > 60 minutes, and presence of alveolar hemorrhage. Thirty-six percent of the non-diagnostic biopsies yielded a malignant diagnosis. In cases with a history of malignancy or the presence of atypical cells in the biopsy sample, a repeat biopsy or surgical intervention should be considered.

Keyword

Adults; Lungs; Biopsy/needle aspiration; Non-diagnostic; Complications

MeSH Terms

Adult
Biopsy
Biopsy, Needle*
Diagnosis*
Emphysema
Hemorrhage
Humans
Logistic Models
Lung*
Needles*
Pathology
Retrospective Studies

Figure

• 

  Fig. 1 Flow diagram shows diagnoses and distribution of initial biopsy results of 894 consecutive biopsies.CLL = chronic lymphocytic leukemia, DLBCL = diffuse large B-cell lymphoma, PTNB = percutaneous transthoracic needle biopsy

• 

  Fig. 2 61-year-old woman with carcinoid tumor.Prone unenhanced chest CT scan obtained during PTNB revealed left lower lobe nodule surrounded with minimal alveolar hemorrhage. Diagnosis was made on FNA. FNA = fine needle aspiration

• 

  Fig. 3 77-year-old man with amyloidoma.Prone unenhanced chest CT scan obtained during PTNB revealed right upper lobe nodule with calcification. Diagnosis was made on CNB. CNB = core needle biopsy

• 

  Fig. 4 77-year-old woman with final diagnosis of squamous cell carcinoma.(A) Localizing CT scan showed 1.4-cm central right lower lobe nodule (B) CT scan during biopsy revealed small pneumothorax and minimal alveolar hemorrhage around nodule and along needle tract. Fine needle aspirate was non-diagnostic and CNB was not performed. Final diagnosis was made at surgery.

• 

  Fig. 5 56-year-old woman with final diagnosis of histoplasmoma.(A) Localizing CT scan revealed 1.6-cm peripheral nodule in left upper lobe (B) CT scan obtained during biopsy revealed minimal alveolar hemorrhage around nodule. PTNB (both FNA and CNB) was non-diagnostic and final diagnosis was made at surgery.

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