Computed tomography-guided cutting needle pleural biopsy: Accuracy and complications

Our plain-English summary of Computed tomography-guided cutting needle pleural biopsy: Accuracy and complications, by Y.Y. Cao, N. Fan, F. Xing, et al (Experimental and Therapeutic Medicine, 2015).

The study

• Authors: Y.Y. Cao, N. Fan, F. Xing, L.Y. Xu, Y.J. Qu, M.Y. Liao
• Journal: Experimental and Therapeutic Medicine
• Published: 2015;9(1):262-266
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

In cases of pleural lesion, tissue samples can be obtained through thoracoscopy or closed needle biopsy for histopathological analysis. Cutting needle biopsy is a relatively recent addition to these techniques. The aim of this study was to evaluate the diagnostic accuracy and safety of computed tomography-guided cutting needle pleural biopsy (CT-CNPB), as well as the associated complications, in patients with pleural lesion. This study was a retrospective analysis of 92 percutaneous CT-CNPBs on 90 patients between March 2008 and May 2013. For group comparisons, χ2 tests were used to detect the risk factors for diagnostic accuracy (false-negative rate). Of the 92 CT-CNPBs, malignant lesions were diagnosed in 55 cases (mesothelioma in 12, metastatic pleural disease in 36, synoviosarcoma in one, indeterminate-origin disease in one and false-negative lesion in five) and benign pleural disease was diagnosed in 37 cases (inflammation in 15, tuberculosis in 10, granuloma in three, solitary fibrous tumor in two, hematoma in one, fungus in one and indeterminate-origin disease in five). The sensitivity of diagnostic malignant lesion was 90.9%, and the specificity and positive and negative predictive values were 100, 100 and 88.1%, respectively. The overall diagnostic accuracy was 94.6%. A specific diagnosis was achieved in 89.1% of malignant lesions and 86.4% of benign lesions. Univariate analysis of the risk factors affecting accuracy (false-negative rate) did not reveal any significant differences (all P>0.05). The complication rates were 6.5% for pneumothorax, 8.7% for hemorrhage and 1.1% for hemothorax. In conclusion, CT-CNPB is a safe and accurate diagnostic technique that can be recommended as the primary method of diagnosis in patients with pleural thickening or lesions observed by CT scan.

In plain English

This retrospective study came from the radiology department of Zhongnan Hospital of Wuhan University in China. It reviewed 92 CT-guided cutting needle biopsies of the pleura (the lining around the lungs), done on 90 patients between March 2008 and May 2013. It did not study asbestos exposure. In the end, 55 cases were classified as malignant, including 12 mesotheliomas and 36 cases of metastatic pleural disease. Another 37 were classified as benign, including 15 of inflammation and 10 of tuberculosis. For detecting cancer, sensitivity was 90.9%: the biopsies found cancer in 50 of the 55 malignant cases and missed five. Specificity was 100% (37 of 37), and overall accuracy was 94.6% (87 of 92). No tested factor, such as sex, age, lesion location or lesion thickness, showed a statistically significant link with missed cancers. Air in the chest outside the lung (pneumothorax) followed 6.5% of biopsies, and mild lung bleeding followed 8.7%. Bleeding into the chest cavity (hemothorax) occurred in one patient. The authors concluded the technique is safe and accurate and suggested it as a first diagnostic step when CT shows pleural thickening or lesions.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective analysis of CT-guided cutting needle pleural biopsies (diagnostic accuracy and complications study)
• Who was studied: 90 patients (53 males, 37 females; mean age 55.2 plus or minus 14.5 years) who underwent 92 biopsies between March 2008 and May 2013. The study was approved by the ethics committee of Zhongnan Hospital of Wuhan University, Wuhan, China, the authors' institution. Patients with lung-based tumors or no final diagnosis were excluded.
• Exposure: No asbestos or fiber exposure was studied. The study evaluated a biopsy procedure: CT-guided pleural biopsy with an 18-gauge coaxial automated cutting needle (Bard Max-Core).
• Main results:
  • Of the 92 cases, 55 were classified as malignant and 37 as benign. The malignant total includes five false-negative cases, where the biopsy missed the cancer. Among the malignant cases, Table I lists mesothelioma in 12 and metastatic pleural disease in 36.
  • For malignant lesions, sensitivity was 90.9% (50/55) and specificity was 100% (37/37). The positive predictive value was 100% (50/50) and the negative predictive value was 88.1% (37/42).
  • Overall diagnostic accuracy across all 92 biopsies was 94.6% (87/92).
  • A specific histological diagnosis was reached in 89.1% (49/55) of malignant lesions and 86.5% (32/37) of benign lesions.
  • Univariate analysis of possible risk factors for false-negative results found no significant differences (all P greater than 0.05). The factors tested were gender, age, lesion location, lesion thickness, number of attempts, pleural effusion and contrast enhancement.
  • Pneumothorax occurred in six cases (6.5%), all in the group with pleural thickness over 30 mm. Five (5.4%) were mild, and one (1.1%) was severe and required a chest drain.
  • Mild lung hemorrhage around the entry site occurred in eight cases (8.7%).
  • One patient (1.1%), who had a history of long-term oral aspirin use, had a hemothorax that required tube thoracostomy. No cases required blood transfusion, and no patients died in the three days after the procedure.
• The authors' conclusion: The authors concluded that CT-guided cutting needle pleural biopsy is a safe and accurate diagnostic technique. They suggested it be used as a first diagnostic evaluation when thoracic CT shows pleural thickness or a pleural lesion.
• Limitations the authors state:
  • The authors noted that 12.0% (11/92) of biopsies gave non-specific results, possibly because of inadequate samples and lesion complexity. In some cases the biopsy alone would not be enough for a final diagnosis, and further investigation and follow-up would be needed.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Biopsy, Thoracoscopy, Needle Biopsy, Mesothelioma, Inflammation, Granuloma, Solitary Fibrous Tumor, Pneumothorax.

Related studies

• Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma — R.F. Adams, W. Gray, et al. (2001)
• Ultrasound-guided percutaneous needle biopsy skill for peripheral lung lesions and complications prevention — H. Zhang, Y. Guang, et al. (2020)
• Diagnostic Accuracy of Ultrasound Guided Percutaneous Pleural Needle Biopsy for Malignant Pleural Mesothelioma — C. Iadevaia, V. D'Agnano, et al. (2024)
• Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial — M. Metintas, G. Ak, et al. (2010)
• Malignant pleural mesothelioma: US-guided histologic core-needle biopsy — A. Heilo, A.E. Stenwig, et al. (1999)
• CT-guided core-needle biopsy in omental pathology — F. Pombo, E. Rodriguez, et al. (1997)

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