Author of

• 11917

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  P2.21 - Poster Session 2 - Diagnosis and Staging (ID 170)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Prevention & Epidemiology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11924

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    P2.21-007 - Computed tomography-guided needle aspiration and biopsy of pulmonary lesions: a single-center experience on 750 biopsies in Japan (ID 3288)

    09:30 - 09:30  |  Author(s): J. Takeshita
    • Abstract

    Background
    Computed tomography (CT)-guided fine needle aspiration (FNA) and biopsy is a well-established diagnostic method for pulmonary lesion.The aim of our study was to update the diagnostic outcomes and the safety profile of CT-guided lung biopsies.

    Methods
    We retrospectively analyzed the results of the CT -guided FNA and biopsies for 750 pulmonary lesions in 696 patients, and investigated the diagnostic yield, and complication rates.The independent risk factors for the diagnostic failure (ie, nondiagnostic, false-positive, and false-negative results) and the complications (severe pneumothorax) were determined using multivariate logistic regression analysis.

    Results
    The study included 417 male patients and 279 female patients, with a mean age of 71 years.The mean lesion size was 2.0 cm in maximal diameter.The biopsy results were nondiagnostic in 1.4% of the lesions (11 of 750 cases).The diagnostic accuracy was 92.6% (685/739cases).The sensitivity and specificity for the diagnosis of malignancy was 91.7% (534 of 582 cases) and 99.3% (156 of 157 cases), respectively.The significant independent risk factor for diagnostic failure was Lesions measuring < 2.0 cm (OR, 3.94; p <0.0001).Pneumothorax was the most common complication, and occurred in 36% (272 cases), pneumothorax requiring temporal drainage or chest tube insertion in 7.3% (55 cases), and tension pneumothorax, in 0.2% (2 cases).There were 27 cases (3.6%) with pulmonary hemorrhage, 63 cases (8.4%) with hemoptysis, 2 cases (0.2%) with air embolism , 5 cases (0.6%) with hypertension requiring antihypertensive treatment , 1 case (0.1%) with posterior reversible encephalopathy syndrome（PRES）, and 8 cases (1.0%) with others, including pain, shock, subcutaneous emphysema, subcutaneous hematoma, epilepsy, and bradycardia or tachycardia spell.From a total of 13 patients with severe complications, 12 patients recovered without sequela, however 1 patient recovered but developed paraplegia due to spinal cord infarction; there were no fatalities.The significant independent risk factors for pneumothorax requiring drainage were the depth from pleura < 3.0 cm (OR, 3.60; p <0.001), lesions in the middle lobe (OR, 2.25; p 0.0284),　and COPD patients(OR, 4.38; p <0.001).

    Conclusion
    CT-guided lung FNA and biopsy have a high diagnostic yield, but factors such as the acquisition of lesions measuring <2.0 cm significantly increased the rate of diagnostic failure.The complication rates were acceptable and comparable to previously published figures.The rate of pneumothorax requiring drainage was correlated with the depth from pleura < 3.0 cm, lesions in the middle lobe, and COPD patients.