CT-GUIDED AUTOMATED NEEDLE-BIOPSY OF THE CHEST

OBJECTIVE. The purpose of this study was to determine the diagnostic a ccuracy and frequency of complications of CT-guided transthoracic need le biopsy done with an automated biopsy system. MATERIALS AND METHODS. Thirty-three consecutive biopsies were performed on 32 patients betwe en February 1999 and July 1994 (mean age, 55 +/- 15 years; 18 men and 14 women). An 18-gauge (n = 28) or 20-gauge (n = 5) needle was used. C ore specimens were submitted for pathologic examination in 10% formali n. No cytopathologist or frozen section analysis was available at the time of biopsy. AII biopsies but one were performed by one chest radio logist. RESULTS. Thirty-one lung biopsies and two mediastinal biopsies yielded a mean lesion size of 4.0 cm (range, 1.2-13.0 cm). Postbiopsy pneumothorax occurred in three (9%) of 33 biopsies; none of the pneum othoraces required placement of a chest tube. The mean number of needl e passes was 1.3 (+/-0.6). Thirty biopsies (91%) yielded sufficient ti ssue for pathologic evaluation. The diagnoses included carcinoma in 14 cases, acute or chronic pneumonia in 4 cases, non-Hodgkin's lymphoma in two cases, and Kaposi's sarcoma, plasma cell granuloma, hypersensit ivity pneumonitis, Pneumocystis carinii pneumonia, and fibrosis in one case each. One patient with a 1.5-cm nodule stable for 1 year on CT h ad fibrosis and chronic inflammation found on needle biopsy, and the n odule was considered benign. Overall, biopsies in 12 (80%) of 15 patie nts without carcinoma were diagnostic. In three patients, the tissue o btained was not representative of the underlying abnormality. The biop sy specimen showed only inflammatory changes in two patients who ultim ately had proved carcinoma. One patient with multiple pulmonary infarc ts due to tumor emboli showed evidence of only pulmonary infarct on bi opsy. Three patients had insufficient tissue for analysis; none of the three had malignant tumor on follow-up. The sensitivity of CT-guided automated needle biopsy of the chest was 84%. CONCLUSION. CT-guided tr ansthoracic needle biopsy of the chest done with an automated biopsy s ystem is safe, with a pneumothorax rate comparable to that of skinny n eedle aspiration. An overall accurate tissue diagnosis was made in 26 (81%) of 32 patients. Biopsies in 12 (80%) of 15 patients without carc inoma were diagnostic, which compares favorably with the reported accu racy of skinny needle aspiration.