title: Computed tomography-guided percutaneous needle biopsy of indeterminate pulmonary pathology: efficacy of obtaining a diagnostic sample in immunocompetent and immunocompromised patients.
abstract: OBJECTIVE
  We aimed to evaluate the efficacy of computed tomography (CT)-guided percutaneous lung biopsy of pulmonary nodules with indeterminate radiologic characteristics in patients at risk for malignant and nonmalignant processes such as infection or inflammation.
  
  
  METHODS
  From January 2003 to September 2008, 262 patients (mean age, 59 years; range, 18-92 years) with pulmonary nodules or a mass of uncertain etiology and with indeterminate radiologic characteristics underwent CT-guided percutaneous lung biopsy. Patients with discordant clinical history and imaging findings or immunocompromised patients at risk for both etiologies were included. Specimens were submitted for both cytology and microbiology.
  
  
  RESULTS
  Of the entire cohort, 166 patients (63.4%) had a nonmalignant process, and 96 patients (36.6%) had a malignancy. CT-guided percutaneous lung biopsy established a diagnosis in 166 patients (63.4%). Of the 166 patients with a nonmalignant etiology and 96 patients with malignancy, it provided a definitive diagnosis in 91 patients (54.8%) and 75 patients (78.1%), respectively, a difference that was statistically significant (P = .0001). Overall diagnostic efficacy between immunocompetent and immunocompromised patients was comparable (P = .2); however, detection of infection or inflammation in individual groups was lower compared with detection of malignancy (P = .002 and P = .06, respectively).
  
  
  CONCLUSIONS
  CT-guided percutaneous lung biopsy in patients who are clinically at risk for both nonmalignant and malignant processes continues to be a challenge. Although CT-guided percutaneous biopsy can establish an accurate diagnosis in a large majority of patients with malignancy, it is significantly less sensitive for infectious or inflammatory processes.
authors.affiliation: Department of Interventional Radiology, Stanford University Medical Center, California, USA. kothary@stanford.edu
authors.forename: Nishita
authors.initials: N
authors.lastname: Kothary
authors.forename: Jason A
authors.initials: JA
authors.lastname: Bartos
authors.forename: Gloria L
authors.initials: GL
authors.lastname: Hwang
authors.forename: Ruchika
authors.initials: R
authors.lastname: Dua
authors.forename: William T
authors.initials: WT
authors.lastname: Kuo
authors.forename: Lawrence V
authors.initials: LV
authors.lastname: Hofmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D005260:Female; D006801:Humans; D007121:Immunocompetence; D016867:Immunocompromised Host; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000276:immunology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D055815:Young Adult