CT fluoroscopy-guided biopsy of 1,000 pulmonary lesions performed with 20-gauge coaxial cutting needles: Diagnostic yield and risk factors for diagnostic failure

Takao Hiraki, Hidefumi Mimura, Hideo Gobara, Toshihiro Iguchi, Hiroyasu Fujiwara, Jun Sakurai, Yusuke Matsui, Daisaku Inoue, Shinichi Toyooka, Yoshifumi Sano, Susumu Kanazawa

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Abstract

Background: Although conventional CT scan-guided needle biopsy is an established diagnostic method for pulmonary lesions, few large studies have been conducted on the diagnostic outcomes of CT fluoroscopy-guided lung biopsy. We have conducted a retrospective analysis to evaluate the diagnostic outcomes of 1,000 CT fluoroscopy-guided lung biopsies performed with 20-gauge coaxial cutting needles. Methods: We determined the diagnostic yield of CT fluoroscopy-guided lung biopsies performed with 20-gauge coaxial cutting needles for 1,000 lesions in 901 patients. Independent risk factors for diagnostic failure (ie, nondiagnostic, false-positive, and false-negative results) were determined with multivariate logistic regression analysis. Results: The biopsy results were nondiagnostic in 0.6% of the lesions (6 of 1,000 lesions). The sensitivity and specificity for the diagnosis of malignancy was 94.2% (741 of 787 lesions) and 99.1% (211 of 213 lesions), respectively; diagnostic accuracy was 95.2% (952 of 1,000 lesions). For lesions measuring ≤ 1.0 cm, the diagnostic accuracy was 92.7% (140 of 151 lesions). The significant independent risk factors for diagnostic failure were as follows: the acquisition of two or fewer specimens (odds ratio [OR], 2.43; p = 0.007), lesions in the lower lobe (OR, 2.50; p = 0.003), malignant lesions (OR, 7.16; p = 0.007), and lesions measuring ≤ 1.0 cm (OR, 3.85; p = 0.016) and ≥ 3.1 cm (OR, 4.32; p = 0.007). Conclusions: CT fluoroscopy-guided lung biopsy performed with 20-gauge coaxial cutting needles resulted in a high diagnostic yield, even in the case of small lesions. Factors such as the acquisition of two or fewer specimens, lesions in the lower lobe, malignant lesions, and lesions measuring ≤1.0 cm or ≥ 3.1 cm significantly increased the rate of diagnostic failure.

Original languageEnglish
Pages (from-to)1612-1617
Number of pages6
JournalChest
Volume136
Issue number6
DOIs
Publication statusPublished - Dec 1 2009

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Fluoroscopy
Needles
Odds Ratio
Biopsy
Lung
Needle Biopsy
Logistic Models
Regression Analysis
Sensitivity and Specificity
Neoplasms

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{6ae8ca0a6d214469bcd2438bf81aa4b8,
title = "CT fluoroscopy-guided biopsy of 1,000 pulmonary lesions performed with 20-gauge coaxial cutting needles: Diagnostic yield and risk factors for diagnostic failure",
abstract = "Background: Although conventional CT scan-guided needle biopsy is an established diagnostic method for pulmonary lesions, few large studies have been conducted on the diagnostic outcomes of CT fluoroscopy-guided lung biopsy. We have conducted a retrospective analysis to evaluate the diagnostic outcomes of 1,000 CT fluoroscopy-guided lung biopsies performed with 20-gauge coaxial cutting needles. Methods: We determined the diagnostic yield of CT fluoroscopy-guided lung biopsies performed with 20-gauge coaxial cutting needles for 1,000 lesions in 901 patients. Independent risk factors for diagnostic failure (ie, nondiagnostic, false-positive, and false-negative results) were determined with multivariate logistic regression analysis. Results: The biopsy results were nondiagnostic in 0.6{\%} of the lesions (6 of 1,000 lesions). The sensitivity and specificity for the diagnosis of malignancy was 94.2{\%} (741 of 787 lesions) and 99.1{\%} (211 of 213 lesions), respectively; diagnostic accuracy was 95.2{\%} (952 of 1,000 lesions). For lesions measuring ≤ 1.0 cm, the diagnostic accuracy was 92.7{\%} (140 of 151 lesions). The significant independent risk factors for diagnostic failure were as follows: the acquisition of two or fewer specimens (odds ratio [OR], 2.43; p = 0.007), lesions in the lower lobe (OR, 2.50; p = 0.003), malignant lesions (OR, 7.16; p = 0.007), and lesions measuring ≤ 1.0 cm (OR, 3.85; p = 0.016) and ≥ 3.1 cm (OR, 4.32; p = 0.007). Conclusions: CT fluoroscopy-guided lung biopsy performed with 20-gauge coaxial cutting needles resulted in a high diagnostic yield, even in the case of small lesions. Factors such as the acquisition of two or fewer specimens, lesions in the lower lobe, malignant lesions, and lesions measuring ≤1.0 cm or ≥ 3.1 cm significantly increased the rate of diagnostic failure.",
author = "Takao Hiraki and Hidefumi Mimura and Hideo Gobara and Toshihiro Iguchi and Hiroyasu Fujiwara and Jun Sakurai and Yusuke Matsui and Daisaku Inoue and Shinichi Toyooka and Yoshifumi Sano and Susumu Kanazawa",
year = "2009",
month = "12",
day = "1",
doi = "10.1378/chest.09-0370",
language = "English",
volume = "136",
pages = "1612--1617",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "6",

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TY - JOUR

T1 - CT fluoroscopy-guided biopsy of 1,000 pulmonary lesions performed with 20-gauge coaxial cutting needles

T2 - Diagnostic yield and risk factors for diagnostic failure

AU - Hiraki, Takao

AU - Mimura, Hidefumi

AU - Gobara, Hideo

AU - Iguchi, Toshihiro

AU - Fujiwara, Hiroyasu

AU - Sakurai, Jun

AU - Matsui, Yusuke

AU - Inoue, Daisaku

AU - Toyooka, Shinichi

AU - Sano, Yoshifumi

AU - Kanazawa, Susumu

PY - 2009/12/1

Y1 - 2009/12/1

N2 - Background: Although conventional CT scan-guided needle biopsy is an established diagnostic method for pulmonary lesions, few large studies have been conducted on the diagnostic outcomes of CT fluoroscopy-guided lung biopsy. We have conducted a retrospective analysis to evaluate the diagnostic outcomes of 1,000 CT fluoroscopy-guided lung biopsies performed with 20-gauge coaxial cutting needles. Methods: We determined the diagnostic yield of CT fluoroscopy-guided lung biopsies performed with 20-gauge coaxial cutting needles for 1,000 lesions in 901 patients. Independent risk factors for diagnostic failure (ie, nondiagnostic, false-positive, and false-negative results) were determined with multivariate logistic regression analysis. Results: The biopsy results were nondiagnostic in 0.6% of the lesions (6 of 1,000 lesions). The sensitivity and specificity for the diagnosis of malignancy was 94.2% (741 of 787 lesions) and 99.1% (211 of 213 lesions), respectively; diagnostic accuracy was 95.2% (952 of 1,000 lesions). For lesions measuring ≤ 1.0 cm, the diagnostic accuracy was 92.7% (140 of 151 lesions). The significant independent risk factors for diagnostic failure were as follows: the acquisition of two or fewer specimens (odds ratio [OR], 2.43; p = 0.007), lesions in the lower lobe (OR, 2.50; p = 0.003), malignant lesions (OR, 7.16; p = 0.007), and lesions measuring ≤ 1.0 cm (OR, 3.85; p = 0.016) and ≥ 3.1 cm (OR, 4.32; p = 0.007). Conclusions: CT fluoroscopy-guided lung biopsy performed with 20-gauge coaxial cutting needles resulted in a high diagnostic yield, even in the case of small lesions. Factors such as the acquisition of two or fewer specimens, lesions in the lower lobe, malignant lesions, and lesions measuring ≤1.0 cm or ≥ 3.1 cm significantly increased the rate of diagnostic failure.

AB - Background: Although conventional CT scan-guided needle biopsy is an established diagnostic method for pulmonary lesions, few large studies have been conducted on the diagnostic outcomes of CT fluoroscopy-guided lung biopsy. We have conducted a retrospective analysis to evaluate the diagnostic outcomes of 1,000 CT fluoroscopy-guided lung biopsies performed with 20-gauge coaxial cutting needles. Methods: We determined the diagnostic yield of CT fluoroscopy-guided lung biopsies performed with 20-gauge coaxial cutting needles for 1,000 lesions in 901 patients. Independent risk factors for diagnostic failure (ie, nondiagnostic, false-positive, and false-negative results) were determined with multivariate logistic regression analysis. Results: The biopsy results were nondiagnostic in 0.6% of the lesions (6 of 1,000 lesions). The sensitivity and specificity for the diagnosis of malignancy was 94.2% (741 of 787 lesions) and 99.1% (211 of 213 lesions), respectively; diagnostic accuracy was 95.2% (952 of 1,000 lesions). For lesions measuring ≤ 1.0 cm, the diagnostic accuracy was 92.7% (140 of 151 lesions). The significant independent risk factors for diagnostic failure were as follows: the acquisition of two or fewer specimens (odds ratio [OR], 2.43; p = 0.007), lesions in the lower lobe (OR, 2.50; p = 0.003), malignant lesions (OR, 7.16; p = 0.007), and lesions measuring ≤ 1.0 cm (OR, 3.85; p = 0.016) and ≥ 3.1 cm (OR, 4.32; p = 0.007). Conclusions: CT fluoroscopy-guided lung biopsy performed with 20-gauge coaxial cutting needles resulted in a high diagnostic yield, even in the case of small lesions. Factors such as the acquisition of two or fewer specimens, lesions in the lower lobe, malignant lesions, and lesions measuring ≤1.0 cm or ≥ 3.1 cm significantly increased the rate of diagnostic failure.

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U2 - 10.1378/chest.09-0370

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