CT fluoroscopy-guided biopsy of 1,000 pulmonary lesions performed with 20-gauge coaxial cutting needles: diagnostic yield and risk factors for diagnostic failure.
BACKGROUND
Although conventional CT scan-guided needle biopsy is an established diagnostic method for pulmonary lesions, few large studies have been conducted on the diagnostic outcomes of CT fluoroscopy-guided lung biopsy. We have conducted a retrospective analysis to evaluate the diagnostic outcomes of 1,000 CT fluoroscopy-guided lung biopsies performed with 20-gauge coaxial cutting needles.


METHODS
We determined the diagnostic yield of CT fluoroscopy-guided lung biopsies performed with 20-gauge coaxial cutting needles for 1,000 lesions in 901 patients. Independent risk factors for diagnostic failure (ie, nondiagnostic, false-positive, and false-negative results) were determined with multivariate logistic regression analysis.


RESULTS
The biopsy results were nondiagnostic in 0.6% of the lesions (6 of 1,000 lesions). The sensitivity and specificity for the diagnosis of malignancy was 94.2% (741 of 787 lesions) and 99.1% (211 of 213 lesions), respectively; diagnostic accuracy was 95.2% (952 of 1,000 lesions). For lesions measuring <or= 1.0 cm, the diagnostic accuracy was 92.7% (140 of 151 lesions). The significant independent risk factors for diagnostic failure were as follows: the acquisition of two or fewer specimens (odds ratio [OR], 2.43; p = 0.007), lesions in the lower lobe (OR, 2.50; p = 0.003), malignant lesions (OR, 7.16; p = 0.007), and lesions measuring <or= 1.0 cm (OR, 3.85; p = 0.016) and >or= 3.1 cm (OR, 4.32; p = 0.007).


CONCLUSIONS
CT fluoroscopy-guided lung biopsy performed with 20-gauge coaxial cutting needles resulted in a high diagnostic yield, even in the case of small lesions. Factors such as the acquisition of two or fewer specimens, lesions in the lower lobe, malignant lesions, and lesions measuring <or= 1.0 cm or >or= 3.1 cm significantly increased the rate of diagnostic failure.
Hiraki
Takao
T
Department of Radiology, Okayama University Medical School, Okayama, Japan. Electronic address: takaoh@tc4.so-net.ne.jp.
Mimura
Hidefumi
H
Department of Radiology, Okayama University Medical School, Okayama, Japan.
Gobara
Hideo
H
Department of Radiology, Okayama University Medical School, Okayama, Japan.
Iguchi
Toshihiro
T
Department of Radiology, Okayama University Medical School, Okayama, Japan.
Fujiwara
Hiroyasu
H
Department of Radiology, Okayama University Medical School, Okayama, Japan.
Sakurai
Jun
J
Department of Radiology, Okayama University Medical School, Okayama, Japan.
Matsui
Yusuke
Y
Department of Radiology, Okayama University Medical School, Okayama, Japan.
Inoue
Daisaku
D
Department of Radiology, Okayama University Medical School, Okayama, Japan.
Toyooka
Shinichi
S
Department of Cancer and Thoracic Surgery, Okayama University Medical School, Okayama, Japan.
Sano
Yoshifumi
Y
Department of Cancer and Thoracic Surgery, Okayama University Medical School, Okayama, Japan.
Kanazawa
Susumu
S
Department of Radiology, Okayama University Medical School, Okayama, Japan.
D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods*; D003951:Diagnostic Errors; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000473:pathology*; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*