EARLY EXPERIENCE WITH CT-GUIDED CORE BIOPSY OF LUNG TUMORS: DOES SIZE PREDICT DIAGNOSTIC ACCURACY AND COMPLICATION RATE?
Abstract
Author(s): Shahnawaz Ansari M.D., David Schwartzberg M.D., Ryane Panasiti M.D., Utkarsh Anil B.A.
Lung cancer remains the leading cause of cancer-related deaths and is expected to increase over the next decade. The World Health Organization and the National Comprehensive Cancer Network (NCCN) hav e advocated a low dose computed tomography (LDCT) scan of the chest for individuals at high risk for lung cancer3. With the proliferation in CT scans performed annually, there has been a corresponding increase in lung nodules identification resulting in an increase in invasive procedures to obtain a tissue diagnosis8. Given the increasing number of sub-centimeter lung nodules detected, this pilot study sought to determine if there is a size limit where a successful biopsy is outweighed by the potential risks, i.e. the risk of clinically significant pneumothorax. A retrospective review of CT-guided core lung biopsies performed on 98 patients between January 2013 and January 2015 was performed. The diagnosis and pneumothorax rates were analyzed for <1 cm, 1-2 cm, 2-3 cm, 3-5cm, and >5 cm pulmonary lesions. The presence of clinically significant pneumothorax (requiring tube thoracostomy) was obtained from the patient Electronic Medical Record (EMR). The overall diagnosis and pneumothorax rates were 94.0% and 7.0% respectively. The diagnosis rate was 87.5% for <1 cm, 86.67% for 1-2 cm, 100% for 2-3 cm, 95.45% for 3-5 cm, and 100% for >5 cm pulmonary lesions. The clinically significant pneumothorax rate was 12.5% for <1 cm, 10.0% for 1-2 cm, 18.7% for 2-3 cm, 0% for 3-5 cm, and 0% for >5 cm pulmonary lesions. Our findings show a high level of diagnostic accuracy for core biopsies of lung tumors of all sizes, including sub-centimeter lung nodules while the clinically significant pneumothorax rate remained unchanged. Given this data, we believe core biopsy of small (<1cm) pulmonary nodules can be performed without a significant rise in the rate of clinically significant pneumothorax, providing for earlier detection and treatment of lung carcinoma. Keywords: Lung cancer, Biopsy, pneumothorax.
