Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy in cavitary pulmonary lesions
Introduction
Cavitary pulmonary lesions are defined radiologically as gas-filled area of the lung surrounded by thickened wall within a pulmonary mass, nodule, or consolidation [1]. The presence of cavity is a nonspecific finding that may be found in many malignant tumors or benign pulmonary lesions. The chest radiography and computed tomographic findings of benign and malignant cavitary pulmonary lesions are usually overlapped [2], [3], [4], thus a correct diagnosis of cavitary pulmonary lesions cannot always be established by these methods before the treatment design.
CT-guided transthoracic biopsy is a well-established method in the cytologic or histologic diagnosis of pulmonary lesions. Owing to the high diagnostic accuracy, sensitivity, specificity, and negative predictive value, it has become the mainstay for nonsurgical procurement of tissues from the lungs [5]. Compared with fine-needle aspiration biopsy (FNAB), core needle biopsy (CNB) with use of large cutting needles usually provides cores of good quality for histopathologic analysis, that allows tumor architecture evaluation and numerous immunohistochemical stainings [6]. However, complications associated with CNB, e.g. pneumothorax, hemoptysis or massive peritumoral hemorrhage, are of major concern [6], [7]. Significant and moderate degrees of pneumothorax, hemoptysis or peritumoral hemorrhage can be life-threatening and require urgent interventions.
FNAB is considered as another relatively safe procedure and same accurate method [8], [9], [10]. The diagnostic accuracy of FNAB achieved greater than 90% in malignant pulmonary diseases, though it could vary from 64% to 97% [5], [8], [9], [11], [12], [13]. Similar to CNB, complications such as pneumothorax, hemoptysis or massive peritumoral hemorrhage are the common major concern of FNAB [9]. Previously, the reported pneumothorax rate in CT-guided transthoracic biopsy vary largely and ranges from 8% to 65% [7], [8], [9], [13], [14], [15], [16], and hemorrhage rate ranges from 4% to 30% [6], [7], [9], [17], depending on location and size of the lesion, needle size, lesion depths, patient status (e.g. age, pulmonary function), numbers of puncture as well as experience of the operators. So far, the knowledge of the diagnostic accuracy and related complications are collected from the biopsy of pulmonary solid lesions. The use of CT-guided FNAB, specifically for cavitary pulmonary lesions has not been reported. The knowledge of its diagnostic performance and the associated complications is still limited.
In this study, we prospectively investigated the feasibility and safety of CT-guided FNAB in cavitary pulmonary lesions in a large cohort. The purpose of this study was to determine the diagnostic performance and safety of CT-guided FNAB in cavitary pulmonary lesions.
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Patients
102 consecutive patients with pulmonary cavitary lesions were included between March 2008 and March 2011. Two radiologists who had 5 and 10 years of experience in chest CT interpretation identified cavitary lesions on chest CT by consensus. Cavity is defined as areas of lucency surrounded by thickened wall within a pulmonary mass, nodule, or consolidation. Exclusion criteria were lung lesions <5 mm (calculated as the mean of the long and short axis), uncooperative patients, lung lesions <1.0 cm
Results
The tissue obtained from the biopsy was adequate for histological analysis in all patients. The obtained tumor samples ranged from 0.5 cm to 1.5 cm in length. The lesions were located in the left upper lobe in 20 patients and in the left lower lobe in 16 patients, in the right upper lobe in 28 patients, in the right middle lobe in 2 patients and in the right lower lobe in 36 patients. The averaged longest cross-sectional diameter of the lesions was 36 mm (range, 10–70 mm). 24 patients had lesions
Discussion
The results of our study show that FNAB can reveal diagnostic results vast majority of pulmonary cavitary leisons. The overall sensitivity, specificity, and accuracy of FNAB could achieve 96.3%, 98.0%, and 96.1%, respectively. The sensitivity, specificity, and diagnosis accuracy in different lesion size (<2 cm vs ≥2 cm), or different cavity wall thickness (<5 mm vs ≥5 mm) were not different, whereas, more nondiagnostic sample was found in wall thickness <5 mm lesions. The incidence of biopsy
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