Percutaneous CT-guided biopsy of the lung: Comparison between aspiration and automated cutting needles using a coaxial technique

Purpose: To compare the accuracy and complication rate of two different CT- guided transthoracic needle biopsy techniques: fine needle aspiration and a n automated biopsy device. Methods: Two consecutive series of respectively 125 (group A) and 98 (group B) biopsies performed using 20-22 gauge coaxial fine needle aspiration (gr oup A) and an automated 19.5 gauge coaxial biopsy device (group B) were com pared in terms of their accuracy and complication rate. Results: Groups A and B included respectively 100 (80%) and 77 (79%) malign ant lesions and 25 (20%) and 18 (21%) benign lesions. No significant differ ence was found between the two series concerning patients, lesions, and pro cedural variables. For a diagnosis of malignancy, a statistically significa nt difference in sensitivity was found (82.7% vs 97.4%) between results obt ained with the automated biopsy device and fine needle aspiration respectiv ely. For a diagnosis of malignancy, the false negative rate of the biopsy r esult was significantly higher (p < 0.005 in group A (17%) than in group B (2.6%). For a specific diagnosis of benignity, no statistically significant difference was found between the two groups (44% vs 26%) but the automated biopsy device provided fewer indeterminate cases. There was no difference between the two groups concerning the pneumothorax rate, which was 20% in g roup A and 15% in group B, or the hemoptysis rare, which was 3.4% in Stoup A and 4% in group B. Conclusion: For a diagnosis of malignancy when a cytopathologist is not ava ilable on-site, automated biopsy devices provide a lower rate of false nega tive results and a similar complication rate to fine needle aspiration.