Computed Tomography–Guided Percutaneous Needle Biopsy of Pulmonary Nodules: Impact of Nodule Size on Diagnostic Accuracy

Impact of Nodule Size on Diagnostic Accuracy

Nishita Kothary; Laura Lock; Daniel Y. Sze; Lawrence V. Hofmann


Clin Lung Cancer 

In This Article

Abstract and Introduction


Purpose: This study was undertaken to compare the diagnostic accuracy and complication rate of computed tomography (CT)–guided percutaneous lung biopsies of lung nodules ≤ 1.5 cm versus > 1.5 cm in diameter.
Patients and Methods: A total of 139 patients (age range, 18–89 years; mean, 62.5 years) underwent CT-guided percutaneous fine-needle aspiration biopsy or 20-gauge core biopsy using an automated biopsy gun. In 37 patients, the lung nodule measured ≤ 1.5 cm (mean, 1.1 cm), and in 102 patients, the lung nodule was > 1.5 cm (mean, 2.8 cm). Diagnostic accuracy was determined by cytopathology results. Major and minor complications were documented.
Results: Overall diagnostic accuracy, pneumothorax rate, and thoracostomy tube insertion rates were 67.6%, 34.5%, and 5%, respectively. Of the 98 patients with malignancy, 77 patients (78.6%) had a definite diagnostic biopsy. Overall, nodules > 1.5 cm were statistically more likely to result in a diagnostic specimen (73.5%) than nodules ≤ 1.5 cm (51.4%; P = .012). Similarly, diagnostic accuracy for malignancy was higher in nodules > 1.5 cm than in those ≤ 1.5 cm (81.3% vs. 69.6%); however, this was not statistically significant. There was no correlation between nodule size and the incidence of complications.
Conclusion: Overall, diagnostic accuracy of CT-guided percutaneous lung biopsy of lung nodules ≤ 1.5 cm is slightly lower than that of nodules > 1.5 cm. However, the diagnostic accuracy for malignancy is high in both groups, with a low risk of complications.


More people die of lung cancer than any other cancer. In 2004 (last available census), 158,006 patients died either directly as a result of lung cancer or of complications from lung cancer.[1] Early detection of malignant small nodules can lead to early treatment that can potentially be curative.[2] With the increasing utility of computed tomography (CT) as well as low-dose screening CT in high-risk patients, the sensitivity of identifying small lung nodules has dramatically increased.[3] The lungs are also a common site for metastases from other primary cancers, such as breast and colon cancer, and the frequent use of positron emission tomography has led to the early detection of metastatic disease.[4] In order to offer optimal treatment, a tissue specimen from the lung nodule is often needed. Currently, percutaneous transthoracic needle biopsy is the technique of choice to establish a tissue diagnosis of malignancy.[5–9] Both fine-needle aspiration biopsy (FNAB) and core biopsy using an automated biopsy gun (referred to as CB henceforth) have proven to have high diagnostic yield with few complications.[5–13] However, most of the literature regarding the diagnostic yield is based on percutaneous transthoracic biopsies of relatively large nodules. The purpose of our study was to evaluate whether there is a difference in the rate of diagnostic accuracy or yield and complications of biopsies when nodules ≤ 1.5 cm (small nodules) are compared with nodules > 1.5 cm (large nodules).


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