title: Image-guided 25-gauge needle biopsy for thoracic lesions: diagnostic feasibility and safety.
abstract: OBJECTIVE
  To report our experience regarding the feasibility and safety of 25-gauge needles for biopsy of thoracic lesions.
  
  
  METHODS
  Twenty-six patients with thoracic lesions, predominately pulmonary nodules, measuring 0.7-5.2 cm (mean, 1.6 cm) underwent biopsy with computed tomographic (n = 24), ultrasonographic (n = 1), or fluoroscopic (n = 1) guidance. Nineteen patients had severe chronic obstructive pulmonary disease (COPD), one had severe restrictive lung disease, and one had a coagulopathy; the other five patients had nonpulmonary primary tumors. Biopsy with an inner 25-gauge needle traversing an outer extrapleural coaxial cannula was performed in all patients. Cytologic quick staining was performed routinely to determine specimen adequacy and to establish a preliminary diagnosis. Complications, specimen adequacy, and need for larger specimens were evaluated.
  
  
  RESULTS
  Adequate specimens (as determined by cytopathologists) were obtained in 24 (92%) of 26 patients, with a definitive diagnosis achieved in 23 (88%) patients during initial quick staining (17 malignant and six benign diagnoses). Two cases initially considered suspicious for malignancy were reclassified as benign (thymoma and histoplasmosis). At the request of cytopathologists, a larger needle was used to supplement the 25-gauge needle in six patients: In one patient, it provided further diagnostic information; in four, it did not; and in one, it confirmed non-Hodgkin lymphoma. Five patients developed a small pneumothorax (<10%) with use of the 25-gauge needle alone; one other patient, in whom larger needles were placed, received a radiologic chest catheter to evacuate the pneumothorax, thereby allowing the biopsy to continue.
  
  
  CONCLUSIONS
  Image-guided 25-gauge needle biopsy is both feasible and safe.
authors.affiliation: Department of Radiology, Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, 44 Binney St, Boston, MA 02115, USA. evansonnenberg@partners.org
authors.forename: Eric
authors.initials: E
authors.lastname: vanSonnenberg
authors.forename: Brian W
authors.initials: BW
authors.lastname: Goodacre
authors.forename: Gerhard R
authors.initials: GR
authors.lastname: Wittich
authors.forename: Robert
authors.initials: R
authors.lastname: Logrono
authors.forename: Peter T
authors.initials: PT
authors.lastname: Kennedy
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Zwischenberger
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000295:instrumentation*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D013896:Thoracic Diseases / Q000473:pathology*