DIAGNOSTIC ACCURACY AND COMPLICATION RATES OF TRANSTHORACIC CT-GUIDED NON-COAXIAL NEEDLE BIOPSY OF PULMONARY LESIONS

Background: Computed tomography (CT)-guided transthoracic needle biopsy is a well-established method for the diagnosis of various intrapulmonary lesions, with two types of biopsy techniques employed, fine-needle aspiration biopsy (FNAB) and core biopsy (CB). Besides the needle type, other factors such as lesion size, nature of the lesion, experience and skills of interventional radiologist influence the diagnostic accuracy. Objectives: aim to assess the diagnostic accuracy and complication rates of transthoracic CT-guided non-coaxial core biopsies of intrapulmonary lesions classified by lesion size into group (A) <35 mm, (B) 35–50 mm, and (C) >50 mm lesions. Methods: Over a 2-year period, 120 lung biopsies were performed using the non-coaxial biopsy technique with 18G semi-automated true-cut needle. There were 80 (66.40%) male and 40(33.60%) female patients, with a mean age of 64.01±9.18 years (18–85 years). The mean lesion size was 59.6±29.3 mm. The lesions were classified into three groups according to size: group (A) lesion <35 mm (n=25, 20.5%), group (B) lesions 35–50 mm (n=35, 29.5%), and group (C)lesions >50 mm (n=60, 50%). Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for all biopsies, and for each group separately, as well as the incidence of complications. Results: The overall diagnostic accuracy was 91%, with 95.3% sensitivity, 100% specificity, 100% PPV, and 41.6% NPV. For group (A) lesions <35 mm, diagnostic accuracy, sensitivity, and PPV were 100%. The lowest diagnostic accuracy was 85% in lesions >50 mm, with 92.4% sensitivity, 100% specificity, 100% PPV, and 33.3% NPV. An adequate sample was obtained in 111 core biopsies (92.5%), while 9 biopsies (7.5%) were nondiagnostic due to necrosis (5%) and insufficient biopsy material (2.55%). minor pneumothorax is most frequent complication which was occurred in 18.5%; major pneumothorax requiring chest tube occurred in 4 patients (3.3%). Conclusion: the diagnostic accuracy decreased with increasing lesion size. On the other hand, complication rates were higher in smaller lesions group (A), and those more pleural distance from the lesion.