title: Percutaneous computed tomography-guided coaxial core biopsy for small pulmonary lesions with ground-glass attenuation.
abstract: BACKGROUND
  The aim of this study was to investigate the diagnostic value of percutaneous computed tomography (CT)-guided coaxial transthoracic needle biopsy (TNB) for small pulmonary lesions (≤ 3 cm) with persistent ground-glass opacity (GGO).
  
  
  METHODS
  From January 2004 to February 2010, consecutive patients with persistent small GGO lesions (≤ 3 cm) who underwent CT-guided TNB were analyzed. The pathologic results of CT-guided TNB were compared with final diagnoses, and the GGO percentage on CT was correlated with the stromal invasion in surgical pathology.
  
  
  RESULTS
  We performed CT-guided TNB on 1612 patients during the study period. Among them, 55 patients had persistent small GGO lesions (size range 0.5-3.0 cm; 1.72 ± 0.73 cm), 47 were diagnosed with lung adenocarcinomas, and 8 with benign nonspecific lesions. Minor procedure-related complications occurred in 26 patients (47.3%) with small pneumothorax and 11 patients (20.0%) with self-limited mild hemoptysis. The final diagnoses of the 43 patients receiving lobectomy were invasive adenocarcinoma (n = 23), pure bronchioloalveolar carcinoma (n = 19), and mucosa-associated lymphoid tissue lymphoma (n = 1). The diagnostic accuracy was 93.0% (40/43) using CT-guided TNB. Pure GGO lesions had a higher incidence of pure bronchioloalveolar carcinoma than GGO-dominant lesions (70.0% versus 21.7%; p = 0.004). Compared with surgical pathology, stromal invasion was underestimated in 43.5% (10/23) of the TNB specimens, especially in pure GGO lesions (83%, 5/6). In logistic regression analysis, the GGO percentage correlated inversely with stromal tumor invasion (p = 0.0028).
  
  
  CONCLUSIONS
  CT-guided coaxial TNB is a safe and useful method for diagnosing small (≤ 3 cm) persistent GGO lesions. Stromal invasion may be underestimated by TNB in GGO lesions.
authors: Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Chia-Hung
authors: CH
authors: Lu
authors: Cheng-Hsiang
authors: CH
authors: Hsiao
authors: Yeun-Chung
authors: YC
authors: Chang
authors: Jang-Ming
authors: JM
authors: Lee
authors: Jin-Yuan
authors: JY
authors: Shih
authors: Li-An
authors: LA
authors: Wu
authors: Chong-Jen
authors: CJ
authors: Yu
authors: Hon-Man
authors: HM
authors: Liu
authors: Tiffany Ting-Fang
authors: TT
authors: Shih
authors: Pan-Chyr
authors: PC
authors: Yang
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000009:adverse effects; D005260:Female; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D018442:Lymphoma, B-Cell, Marginal Zone / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011030:Pneumothorax / Q000209:etiology; D015642:Radiology, Interventional; D014057:Tomography, X-Ray Computed