Learning objectives
To comprehensively describe the indications,
contraindications,
technical aspects,
diagnostic accuracy and complication rates of conventional CT–guided lung biopsies (FNAB and CNB) in our series.
To show the spectrum of imaging findings we may encounter during this type of procedure.
To share our experience with FNAB and CNB in the diagnosis of lung lesions.
Background
Lung cancer is the leading cause of cancer death in Europe and around the world,
being the most common cancer worldwide since 1985,
both in terms of incidence and mortality.
The increasingly widespread use of imaging in clinical practice has led to a steep increase in incidental findings of asymptomatic solitary pulmonary nodules.
In nodules >10mm and even in smaller nodules with high growth rate,
an histologic analysis is needed to confirm the diagnosis.
It can be achieved by several methods,
including bronchoscopy,
endobronquial ultrasonography...
Findings and procedure details
INDICATIONS
Indeterminate pulmonary lesions in patients with or without known malignancy,
especially those that would require treatments other than surgery (chemotherapy,
radiotherapy,
antibiotics)
Molecular testing in a known malignacy,
mainly non-small cell lung cancer (NSCLC),
to assess the presence of driver mutation (ALK,
ROS 1,
EGFR,
PDL1…) in order to offer a personalized targeted therapy.
CONTRAINDICATIONS
A unique functional lung.
Uncooperative patients (mental status,
mechanical ventilation,
intractable cough…)
Lesions suspected of being vascular in origin.
Uncorrectable coagulopathy.
Anticoagulant or antiplatelet therapy should be suspendend for...
Conclusion
1.
CT–guided lung biopsy (FNA and CNB) has become a great method to obtain lung nodule specimens and avoids the patient an open biopsy in most cases.
2.Compared to FNA,
CNB has a higher accuracy for diagnosis with nosignificant difference in complication rate,
while keeping in mind that FNA is a good technique that may be usefulin certain patients.
3.Minor complications are very common in CT-guided lung biopsy but usually lack of clinical significance for the patient,
being asymptomatic pneumothorax and minimum-mildparenchymal pulmonary hemorrhage the...
References
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Hata A,
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Katakami N.
CT-Guided Fine-Needle Aspiration and Core Needle Biopsies of Pulmonary Lesions: A Single-Center Experience With 750 Biopsies in Japan.
AJR 2015; 204:29–34.
Loubeyre P,
Copercini M,
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Percutaneous CT-Guided Multisampling Core Needle Biopsy of Thoracic Lesions.
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Tzeng...