CT-guided transthoracic needle biopsy of pulmonary lesions: comparison between the cutting needle and aspiration needle.

Objectives: To compare CT-guided transthoracic cutting needle biopsy (TCNB) with transthoracic aspiration needle biopsy (TANB) for pulmonary lesions with respect to the diagnostic accuracy and complication rate.

Methods: Of the 859 cases that underwent consecutive CT-guided biopsy of pulmonary lesions, 713 cases confirmed by surgical pathology or clinical follow-up were enrolled. Of these, the first consecutive 275 cases underwent TANB, and the remaining 438 received TCNB. The final diagnosis determined the accuracy of biopsy. Based on the post-biopsy CT and clinical medical records, the presence or absence of biopsy-related complications was determined. The χ 2 test was used to compare the differences between TCNB and TANB in terms of diagnostic accuracy and complication rate.

Results: Among the 713 biopsy lesions, the final diagnosis was malignant in 411 cases and benign in 302 cases. As compared to TANB, the diagnostic accuracy of TCNB (98.9% vs 93.8%, χ 2 = 14.35, p < 0.01), sensitivity to malignant lesions (97.8% vs 90.6%, χ 2 = 10.58, p < 0.01), negative predictive value (97.6% vs 84.8%, χ 2 = 19.03, p < 0.01), and specific diagnostic rate for benign lesions (73.4% vs 57.9%, χ 2 = 7.29, p < 0.01) were improved. On the other hand, a statistical difference was detected between TCNB and TANB with respect to the incidence of pneumothorax (20.6% vs 13.1%, χ 2 = 6.46, p = 0.01), hemorrhage (32.2% vs 13.1%, χ 2 = 33.03, p < 0.01), and hemoptysis (8.2% vs 3.3%, χ 2 = 6.87, p < 0.01). One patient died just several minutes after TCNB due to severe hemorrhage with hemoptysis.

Conclusions: Compared to TANB, CT-guided TCNB improves the diagnostic accuracy of pulmonary lesions, but complication rate increases significantly.

Advances in Knowledge: In general, TCNB should be recommended, especially for highly suspicious benign lesions. For patients with small lesions adjacent to vessels or vessels within the lesion, TANB should be considered.