title: Small (</=2-cm) subpleural pulmonary lesions: short- versus long-needle-path CT-guided Biopsy--comparison of diagnostic yields and complications.
abstract: OBJECTIVE
  To retrospectively compare the diagnostic yield and complications associated with the use of short versus long needle paths for computed tomography (CT)-guided biopsy of small subpleural lung lesions.
  
  
  METHODS
  The study was approved by the institutional review board, and the requirement for informed patient consent was waived. The medical and imaging records of patients who underwent CT-guided biopsy of subpleural pulmonary nodules measuring up to 2 cm in diameter were reviewed. The study included 176 patients (79 men, 97 women; age range, 18-84 years) who were divided into two groups: In group A, a direct approach in which the needle traversed a short lung segment was used. In group B, an indirect approach involving the use of a longer needle path was used. Diagnostic yield, accuracy, and pneumothorax and chest tube placement rates were compared between the two groups. Two-tailed t tests and Pearson chi(2) tests were used to analyze continuous and categorized variables, respectively.
  
  
  RESULTS
  Group A comprised 48 patients; and group B, 128 patients. The mean needle path length was 0.4 cm in group A and 5.6 cm in group B. The short-path approach necessitated more needle punctures (mean, 2.9 vs 1.8 with long-path approach, P < .001) through the pleura. The diagnostic yield in group A was significantly lower than that in group B (71% vs 94%, P < .001), particularly in patients with small (0-1-cm) nodules (40% in group A vs 94% in group B, P < .001). The frequency of postbiopsy pneumothorax was identical (69%) in the two groups. However, more group B than group A patients required chest tube placement for treatment of pneumothorax (38% vs 17%, P = .006).
  
  
  CONCLUSIONS
  Use of long-needle-path biopsy of subpleural lesions resulted in a higher diagnostic yield, especially for small nodules. However, compared with the short-needle-path technique, this approach was associated with a higher frequency of chest tube placement for pneumothorax.
authors.affiliation: Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 325, Houston, TX 77030, USA. sgupta@di.mdacc.tmc.edu
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gupta
authors.forename: Savitri
authors.initials: S
authors.lastname: Krishnamurthy
authors.forename: Lyle D
authors.initials: LD
authors.lastname: Broemeling
authors.forename: Frank A
authors.initials: FA
authors.lastname: Morello
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wallace
authors.forename: Kamran
authors.initials: K
authors.lastname: Ahrar
authors.forename: David C
authors.initials: DC
authors.lastname: Madoff
authors.forename: Ravi
authors.initials: R
authors.lastname: Murthy
authors.forename: Marshall E
authors.initials: ME
authors.lastname: Hicks
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D015505:Chest Tubes; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009339:Needles; D011030:Pneumothorax / Q000209:etiology; D014057:Tomography, X-Ray Computed