Korean J Radiol.  2015 Feb;16(1):206-212. 10.3348/kjr.2015.16.1.206.

CT-Guided Core Needle Biopsy of Pleural Lesions: Evaluating Diagnostic Yield and Associated Complications

• Niu XK
• Bhetuwal A
• Yang HF

• KMID: 2070002
• DOI: http://doi.org/10.3348/kjr.2015.16.1.206

Abstract

OBJECTIVE
The purpose of this study was to retrospectively evaluate the diagnostic accuracy and complications of CT-guided core needle biopsy (CT-guided CNB) of pleural lesion and the possible effects of influencing factors.
MATERIALS AND METHODS
From September 2007 to June 2013, 88 consecutive patients (60 men and 28 women; mean [+/- standard deviation] age, 51.1 +/- 14.4 years; range, 19-78 years) underwent CT-guided CNB, which was performed by two experienced chest radiologists in our medical center. Out of 88 cases, 56 (63%) were diagnosed as malignant, 28 (31%) as benign and 4 (5%) as indeterminate for CNB of pleural lesions. The final diagnosis was confirmed by either histopathological diagnosis or clinical follow-up. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and complication rates were statistically evaluated. Influencing factors (patient age, sex, lesion size, pleural-puncture angle, patient position, pleural effusion, and number of pleural punctures) were assessed for their effect on accuracy of CT-guided CNB using univariate and subsequent multivariate analysis.
RESULTS
Diagnostic accuracy, sensitivity, specificity, PPV, and NPV were 89.2%, 86.1%, 100%, 100%, and 67.8%, respectively. The influencing factors had no significant effect in altering diagnostic accuracy. As far as complications were concerned, occurrence of pneumothorax was observed in 14 (16%) out of 88 patients. Multivariate analysis revealed lesion size/pleural thickening as a significant risk factor (odds ratio [OR]: 8.744, p = 0.005) for occurrence of pneumothorax. Moreover, presence of pleural effusion was noted as a significant protective factor (OR: 0.171, p = 0.037) for pneumothorax.
CONCLUSION
CT-guided CNB of pleural lesion is a safe procedure with high diagnostic yield and low risk of significant complications.

Keyword

CT-guided core needle biopsy; Pleural biopsy; Complication

MeSH Terms

Adult
Age Factors
Aged
Biopsy, Large-Core Needle/*adverse effects
Female
Humans
Male
Middle Aged
Odds Ratio
Pleural Effusion/*diagnosis/pathology
Pneumothorax/*etiology
Retrospective Studies
Risk Factors
Sensitivity and Specificity
Sex Factors
Tomography, X-Ray Computed
Young Adult

Figure

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  Fig. 1 54-year-old man with multiple pleural-based nodules and right sided pleural effusion undergoing CT-guided biopsy for left anterior nodular pleural lesion measuring 0.8 mm. Histopathology of specimen revealed pleural fibrosis.

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  Fig. 2 46-year-old man with bilateral diffuse pleural thickening undergoing CT-guided biopsy through posterior approach. Pleural thickening at biopsy site was measured to be 10 mm. Histopathology of specimen revealed spindle cell carcinoma.

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