title: CT-guided percutaneous core needle biopsy for small (≤20 mm) pulmonary lesions.
abstract: OBJECTIVE
  To assess the accuracy and risk factors for complications of computed tomography (CT)-guided percutaneous core needle biopsy (CNB) for small (≤20 mm) pulmonary lesions.
  
  
  METHODS
  A retrospective study was undertaken comprising 169 patients who underwent CT-guided CNB for small (≤20 mm) pulmonary lesions. To assess the accuracy of the procedure, the diagnosis at biopsy was compared with the diagnosis after definitive surgery or clinical follow-up. The risk factors for pneumothorax and bleeding were determined by multivariate analysis of variables.
  
  
  RESULTS
  The overall diagnostic accuracy was 93.5%. The sensitivity for malignancy and specificity for benign lesions were 90.4% and 100%, respectively. Positive and negative predictive values were 100% and 83.3%, respectively. Twenty-five patients (14.8%) had pneumothorax after CT percutaneous CNB of the lung. The significant risk factors affecting the incidence of pneumothorax were lesion-pleural distance (p = 0.008) and needle-pleural angle (p = 0.012). The highest rate of pneumothorax correlated with a lesion-pleural distance ≥21 mm (OR = 18.46; 95%CI: 2.27-149.95) and a needle-pleural angle ≥51° (OR = 8.22; 95%CI: 2.14-31.49). Bleeding occurred in 30 patients (17.8%). The only significant risk factor affecting the incidence of bleeding was lesion-pleural distance (p = 0.011). The highest bleeding rate correlated with a lesion-pleural distance ≥21 mm (OR = 7.93; 95%CI: 1.73-36.43).
  
  
  CONCLUSIONS
  CT-guided percutaneous CNB of small (≤20 mm) pulmonary lesions provides high diagnostic accuracy with acceptable complications. A lesion-pleural distance of ≥21 mm and needle-pleural angle of ≥51° are identified as the risk factors for highest pneumothorax rate. In addition, the needle-pleural angle is a novel predictor of pneumothorax. A lesion-pleural distance of ≥21 mm is also identified as a risk factor for the highest bleeding rate.
authors.affiliation: Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.forename: Y
authors.initials: Y
authors.lastname: Du
authors.forename: H F
authors.initials: HF
authors.lastname: Yang
authors.forename: J H
authors.initials: JH
authors.lastname: Yu
authors.forename: X X
authors.initials: XX
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects / Q000379:methods; D008171:Lung Diseases / Q000209:etiology; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000473:pathology*; D011030:Pneumothorax / Q000209:etiology*; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult