Safety and diagnostic performance of image-guided lung biopsy in the targeted therapy era.
OBJECTIVE
To identify risk factors for the adverse events and determine the diagnostic yield of a large series of image-guided thoracic biopsies performed in a single institution.


METHODS
We reviewed a consecutive series of 811 patients (546 males; average age: 68 years.) who underwent 824 image-guided biopsies of pulmonary lesions performed between 2009 and 2013. Indications for biopsy were always evaluated by a multidisciplinary board. All complications were registered. The diagnostic accuracy was calculated on the basis of histology after surgery, response to medical therapy, or outcome at imaging follow-up. Safety and accuracy was correlated with patient-related and lesion-related factors.


RESULTS
61 biopsies were performed under US-guidance, 750 under CT-guidance, and 13 under combined guidance. The average lesion size was 36.4 mm (6-150 mm). FNAB was exclusively performed in 247 patients, whereas 577 patients underwent also or only core biopsy (CB). 40 (4.8 %) major complications and 172 (20.8 %) minor complications occurred. US-guidance, absence of perilesional emphysema and minor depth of the target lesion from the skin resulted as favorable predictors against major complications. According to the gold standard criteria, we demonstrated 497 true positives, 72 true negatives, 18 false negatives, 0 false positives. Sensitivity, specificity and diagnostic accuracy were 96.5, 100 and 97 %. No predictors for accuracy were found, but the number of samples largely related to the pathologist on site.


CONCLUSIONS
Image-guided lung biopsy is safe and highly accurate for diagnosing thoracic lesions. In the targeted therapy era, CB with larger needles can be safely applied when the need for larger amounts of tumor tissue is presumed.
Radiology Unit, Department of Oncology, University of Torino, Regione Gonzole 10, 10043, Orbassano, TO, Italy. busso.marco@gmail.com.
Marco
M
Busso
Radiology Unit, Department of Oncology, University of Torino, Regione Gonzole 10, 10043, Orbassano, TO, Italy.
Diego
D
Sardo
Radiology Unit, Department of Oncology, University of Torino, Regione Gonzole 10, 10043, Orbassano, TO, Italy.
Irene
I
Garetto
Pathology Unit, Department of Oncology, University of Torino, Regione Gonzole 10, 10043, Orbassano, TO, Italy.
Luisella
L
Righi
Radiology Unit, Department of Oncology, University of Torino, Regione Gonzole 10, 10043, Orbassano, TO, Italy.
Giulia
G
Libero
Pulmonary Oncology Unit, Department of Oncology, University of Torino, Regione Gonzole 10, 10043, Orbassano, TO, Italy.
Tiziana
T
Vavalà
Thoracic Surgery Unit, University of Torino, Regione Gonzole 10, 10043, Orbassano, TO, Italy.
Francesco
F
Ardissone
Pulmonary Oncology Unit, Department of Oncology, University of Torino, Regione Gonzole 10, 10043, Orbassano, TO, Italy.
Silvia
S
Novello
Pathology Unit, Department of Oncology, University of Torino, Regione Gonzole 10, 10043, Orbassano, TO, Italy.
Mauro
M
Papotti
Radiology Unit, Department of Oncology, University of Torino, Regione Gonzole 10, 10043, Orbassano, TO, Italy.
Andrea
A
Veltri
D000368:Aged; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects / Q000379:methods*; D008171:Lung Diseases / Q000473:pathology*; D008297:Male; D061214:Patient Safety; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity
Core biopsy; Image-guided biopsy; Lung biopsy; Lung tumor; Targeted therapy