Background: Where pulmonary nodules or masses have been detected, the main objective is to determine if the
lesion is benign or malignant
Purpose: To evaluate the impact of per—cutaneous CT guided needle biopsy in realizing the etiology of peripheral
lung lesions, and to assess the pneumothorax rate as a complication, by applying the lung-lesion-biopsy code.
Patients & procedures: Sixty patients underwent CT-guided per-cutaneous core biopsies with peripheral pulmonary
lesions. Evaluation included corresponding clinical data, pathologic results, and consequent complications.
Considering various items that influence the diagnostic yield and pneumothorax rate, we speculate the most significant
items, including lung factors ( presence of emphysema), lesion variables (size, depth, location, and pleural contact),
biopsy-related factor (degree of difficulty, and type of needle used). Confirmatory thoracoscopy and thoracoscopic
biopsies were done for the patients with peripheral smaller pulmonary lesions <2 cm, as well as the non malignant
peripheral lung lesions, which resulted in CT guided per-cutaneous core biopsies, to confirm the histopathological
outcome.
Results: CT guided biopsy in patients with peripheral lung lesions were non malignant in 40% and malignant in
60% of cases. Malignant lesions were primary lung cancer in 72.22% and secondary lung cancer in 27.78%. Percutaneous
trans-thoracic CT guided needle lung biopsy in relation to definitive diagnosis in the studied patients with
peripheral lung lesions, reflecting False negative rate (10/46, 21.7%), Sensitivity (36/46, 78.3%), Specificity (14/14,
100%), Overall accuracy (50/60, 83%). There were no false-positive findings! Pneumothorax were observed in 6
patients (10%) and 3 of them required a chest drain (5%). There were no hematothoraces or major bleeding
complications; however, post-interventional local hemorrhages were observed in 5 patients, no hemoptysis was
noted.
Conclusion: Per-cutaneous trans-thoracic CT guided needle cutting biopsy is an important scanning tool in
diagnosing peripheral pulmonary lesions greater than 2 cm in diameter, at a low complication rate The lesion size
was a significant factor contributing to diagnostic accuracy of CT guided biopsy, and closely related to the
pneumothorax rate, as well as the pleural contact, and presence of emphysema. Thoracoscopy provides high degree
in accuracy for specific benign diagnosis in peripheral pulmonary lesion and provides higher degree of accuracy
compared with CT guided biopsy for diagnosis of peripheral pulmonary lesions 52 cm in diameter |
