Abstract
Purpose
Previous studies with small sample sizes have shown a wide range of complication rates and no study has investigated the yield of computed tomography-guided transthoracic core needle biopsies (CTTCB) for coccidioidomycosis. To better assess the safety, accuracy, and risk factors for complications of CTTCB of pulmonary nodules, we conducted a retrospective study at a high-volume academic center in an endemic coccidioidomycosis area.
Methods
We conducted a retrospective study of 203 patients who underwent CTTCB of pulmonary nodules between December 2010 and May 2013. We collected demographics, clinical, and radiographic data. Each case was reviewed for complications. Diagnostic accuracy was assessed by comparing CTTCB with final diagnoses.
Results
The overall complication rate was 25 %. Pneumothorax accounted for 24 % of complications with 7 % of pneumothoraces requiring chest tube. 1.5 % were complicated by hemoptysis but none required blood transfusions. There was an association between complications and age, presence of emphysema on CT, traversed lung length, and lesion depth. The overall sensitivity of the CTTCB for all types of lung cancer was 93 %, and specificity of 100 %. The positive predictive value of CTTCB for lung cancer was 100 %. The sensitivity and specificity of CTTCB for a coccidiomycosis lung nodule was 83 % with a specificity of 100 % with a PPV of 100 %.
Conclusion
Our study demonstrates that CTTCB is a relatively safe method for evaluating lung nodules and highly accurate in evaluating lung nodules due to coccidioidomycosis in an endemic area. The primary risk factors for complications from CTTCB are the presence of emphysema on CT scan, lesion depth, and traversed lung length.
Similar content being viewed by others
References
Gould MK, Donington J, Lynch WR et al (2013) Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143(5Suppl):e93S–e120S
Croft DR, Trapp J, Kernstine K et al (2002) FDG-PET imaging and the diagnosis of non-small cell lung cancer in a region of high histoplasmosis prevalence. Lung Cancer 36(3):297–301
Reyes N, Onadeko OO, Luraschi-Monjagatta MD et al (2014) Positron emission tomography in the evaluation of pulmonary nodules among patients living in a coccidioidal endemic region. Lung 192(4):589–593
Khan MF, Straub R, Moghaddam SR et al (2008) Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy. Eur Radiol 18(7):1356–1363
Wiener RS, Wiener DC, Gould MK (2013) Risks of transthoracic needle biopsy: how high? Clin Pulm Med 20(1):29–35
Forseth J, Rohwedder JJ, Levine BE et al (1986) Experience with needle biopsy for coccidioidal lung nodules. Arch Intern Med 146(2):319–320
Loubeyre P, Copercini M, Dietrich PY (2005) Percutaneous CT-guided multisampling core needle biopsy of thoracic lesions. Am J Roentgenol 185(5):1294–1298
Wiener RS, Schwartz LM, Woloshin S et al (2011) Population-based risk for complications after transthoracic needle lung biopsy of a pulmonary nodule: an analysis of discharge records. Ann Intern Med 155(3):137–144
Montaudon M, Latrabe V, Pariente A et al (2004) Factors influencing accuracy of CT-guided percutaneous biopsies of pulmonary lesions. Eur Radiol 14(7):1234–1240 Epub 2004 Feb 13
Heyer CM, Reichelt S, Peters SA et al (2008) Computed tomography-navigated transthoracic core biopsy of pulmonary lesions: which factors affect diagnostic yield and complication rates? Acad Radiol. 15(8):1017–1026
Yeow KM, Su IH, Pan KT et al (2004) Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies. Chest 126(3):748–754
Li Y, Du Y, Yang HF et al (2013) CT-guided percutaneous core needle biopsy for small (≤20 mm) pulmonary lesions. Clin Radiol 68(1):e43–e48
Covey AM, Gandhi R, Brody LA et al (2004) Factors associated with pneumothorax and pneumothorax requiring treatment after percutaneous lung biopsy in 443 consecutive patients. J Vasc Interv Radiol 15(5):479–483
Chakrabarti B, Earis JE, Pandey R et al (2009) Risk assessment of pneumothorax and pulmonary haemorrhage complicating percutaneous co axial cutting needle lung biopsy. Respir Med 103(3):449–455
Yildirim E, Kirbas I, Harman A et al (2009) CT-guided cutting needle lung biopsy using modified coaxial technique: factors effecting risk of complications. Eur J Radiol 70(1):57–60
Saji H, Nakamura H, Tsuchida T et al (2002) The incidence and the risk of pneumothorax and chest tube placement after percutaneous CT-guided lung biopsy: the angle of the needle trajectory is a novel predictor. Chest 121(5):1521–1526
Yamagami T, Nakamura T, Iida S et al (2002) Management of pneumothorax after percutaneous CT-guided lung biopsy. Chest 121(4):1159–1164
Kothary N, Lock L, Sze DY et al (2009) Computed tomography-guided percutaneous needle biopsy of pulmonary nodules: impact of nodule size on diagnostic accuracy. Clin Lung Cancer. 10(5):360–363
Hiraki T, Mimura H, Gobara H et al (2009) CT fluoroscopy-guided biopsy of 1,000 pulmonary lesions performed with 20-gauge coaxial cutting needles: diagnostic yield and risk factors for diagnostic failure. Chest 136(6):1612–1617
Williams A, Tammemagi MC et al (2013) Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med 369(10):910–919
Vansteenkiste JF, Stroobants SS (2006) PET scan in lung cancer: current recommendations and innovation. J Thorac Oncol 1(1):71–73
Reyes N, Onadeko OO et al (2014) Positron emission tomography in the evaluation of pulmonary nodules among patients living in a coccidioidal endemic region. Lung 192(4):589–593
Neff TA (1973) To needle, brush, cut or watch? Chest 63(2):134
Zelch JV, Lalli AF, McCormack LJ et al (1973) Aspiration biopsy in diagnosis of pulmonary nodule. Chest 63(2):149–152
VanSonnenberg E, Casola G, Ho M et al (1988) Difficult thoracic lesions: CT-guided biopsy experience in 150 cases. Radiology 167(2):457–461
Choi SH, Chae EJ et al (2013) Percutaneous CT-guided aspiration and core biopsy of pulmonary nodules smaller than 1 cm: analysis of outcomes of 305 procedures from a tertiary referral center. Am J Roentgenol 201(5):964–970
Chitkara YK (1997) Evaluation of cultures of percutaneous core needle biopsy specimens in the diagnosis of pulmonary nodules. Am J Clin Pathol 107(2):224–228
Anderson JM, Murchison J, Patel D (2003) CT-guided lung biopsy: factors influencing diagnostic yield and complication rate. Clin Radiol 58(10):791–797
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors wish to declare that there is no conflict of financial or personal interest related to this manuscript.
Rights and permissions
About this article
Cite this article
Sachdeva, M., Ronaghi, R., Mills, P.K. et al. Complications and Yield of Computed Tomography-Guided Transthoracic Core Needle Biopsy of Lung Nodules at a High-Volume Academic Center in an Endemic Coccidioidomycosis Area. Lung 194, 379–385 (2016). https://doi.org/10.1007/s00408-016-9866-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00408-016-9866-3