”Enough is not enough” - under what circumstances might seemingly diagnostic CT guided percutaneous transthoracic lung needle biopsy (PTLNB) be insufficient for optimal patient management? In 20-30% of PTLNB procedures the pathologic material obtained may be classified as nondiagnostic [1]. Furthermore, in 10-20% of PTLNB procedures that are diagnostic of malignancy, the results may be insufficient to direct optimal targeted therapy, [2-4]. This is largely because of development of specific targeted therapies and immunotherapies for various tumours, which increasingly require comprehensive immunohistochemical (IHC) and molecular...

Image guided (CT) PTLNB is standard diagnostic procedure for nodules >= 8 mm with intermediate probabilities of malignancy (BTS guideline for investigation and management of pulmonary nodules 2015) [5]. PTLNB pathologic results can be subdivided into five categories: Diagnostic = specific benign findings, malignant findings; Non-diagnostic = nonspecific benign pathologic findings, atypical cells, insufficient specimen. Specific benignity is assigned for results showing distinctive diagnoses such as hamartoma or tuberculosis. Nonspecific benignity is defined when adequate sample without suspicious or malignant features are present, but insufficient...

Study Aim To assess the diagnostic accuracy and clinical utility of PTLNB to guide optimal oncological management (allowing for clinical context) of patients with lung nodule(s) under respiratory and oncology investigation at CCLHD NSW regional thoracic oncology centre over 1.5 year period.Correlation with nodule size and morphology was also performed. Methods Retrospective study of consecutive series of adult patients undergoing PTLNB for focal lung lesion(s) was performed (with institutional Ethics Committee approval for quality improvement study). There were 113 consecutive procedures in 111 patients (M...

In this series of 113 consecutive PTLNB performed for lung nodule evaluation in the general chest interventional radiology setting, the overall nondiagnostic rate was 19.5%, increasing to 26.8% for nodule size <= 20 mm. For confirmed final diagnosis of a malignant nodule, PTLNB false negative rate was 5/85 (5.9%). Further 13/85 (15.3 %) of procedures were limited by insufficient material for optimal oncological management. PTLNB limitation was not adversely impacted by small size - combined false negative and insufficient characterisation rate was 5/30 (16.7%) for...

[1] Lee KH, Lim KY, Suh YJ et al.Nondiagnostic Percutaneous Transthoracic Needle Biopsy of Lung Lesions: A Multicenter Study of Malignancy Risk. Radiology 2019; 290:814–823. [2] Yoon HJ, Lee HY, Lee KS et al. Repeat biopsy for mutational analysis of non-small cell lung cancers resistant to previous chemotherapy: adequacy and complications. Radiology 2012; 265:939-948. [3] Tam AL, Kim ES, Lee JJ et al. Feasibility of image-guided transthoracic core-needle biopsy in the BATTLE lung trial. J Thorac Oncol 2013; 8: 436-442. [4] Tsai EB, Pomykala K,...