Transthoracic lung biopsy for pulmonary nodules ≤20 mm in routine clinical care. Issue 1 (24th January 2022)

• Record Type: Journal Article
• Authors: Lissavalid, Emilie; Khalil, Antoine; Soussi, Ghassen; Debray, Marie-Pierre; Guyard, Alice; Bunel, Vincent; Borie, Raphael; Mordant, Pierre; Cazes, Aurélie; Zalcman, Gérard; Gounant, Valérie
• Is Part Of: ERJ open research. Volume 8:Issue 1(2022)
• Publication Date: 2022-01-24
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; Respiration; Respiratory organs -- Diseases; Respiratory organs -- Diseases -- Treatment; Respiratory Tract Diseases; Electronic journals; Fulltext; Internet Resources; Periodicals; Periodical; 616.2005
• DOI: 10.1183/23120541.00562-2021
• Languages: English
• ISSNs: 2312-0541

Abstract

Background: Computed tomography (CT) screening has improved lung cancer survival, yet increasingly detects small lung lesions. Thus, the number of transthoracic lung biopsies (TTLB) for small nodules is expected to rise significantly. The aim of the present study was to evaluate the diagnostic accuracy and safety of CT-guided TTLB for nodules ≤20 mm versus nodules >20 mm. Study design and methods: Data for CT-guided TTLBs from 474 consecutive patients were prospectively collected over a 3-year period (198 lesions ≤20 mm and 276 lesions >20 mm) in a teaching hospital and analysed in terms of diagnostic performance and complications. Results: There were more conclusive biopsies in the >20 mm lesion group (n=236, 85.5%) than in ≤20 mm lesion group (n=140, 70.7%; p<0.001). The overall accuracy, sensitivity, specificity and negative predictive value for diagnosing malignant lesions after first TTLB were 88.4%, 84%, 100% and 70.1%, respectively, for ≤20 mm lesions, and 94.2%, 93%, 100% and 74.6%, respectively, for >20 mm lesions. Pneumothorax requiring drainage was significantly more common for ≤20 mm lesions, compared to TTLB of larger lesions (9.6% versus 4.3%; p=0.02). Prolonged hospital stay due to pneumothorax occurred in 27 (17.4%) TTLBs of ≤20 mm lesions and 15 (7%) TTLBs of >20 mm lesions (p=0.002). There were no deaths. The only variable significantly associated with diagnostic failure in the ≤20 mm lesion group was the radiologist's experience. Interpretation: TTLBs for lesions ≤20 mm were associated with slightly lower diagnostic performance, whereas the higher rate of major complications was still inferior to that extrapolated from United States insurance databases. Lung cancer screening led to high rate of ≤20 mm nodule discovery. Small-nodule TTLB had 84% sensitivity with 70% NPV for cancer diagnosis. Pneumothorax needing chest tube insertion occurred in 9.6% of TTLBs for lesions ≤20 mm. No death was observed. https://bit.ly/3ohTd7f