Small (≤ 20 mm) ground-glass opacity pulmonary lesions: which factors influence the diagnostic accuracy of CT-guided percutaneous core needle biopsy?

Efficacy of modified technique for 1 cm core needle biopsy using a 2 cm cutting length with coaxial introducer needle

PURPOSE

This study evaluated the efficacy of a modified core needle biopsy using a 2 cm stroke length to improve tissue yield for molecular analyses in cancer genomics medicine.

METHODS

In vitro biopsy weight evaluations were performed using agarose gels of varying hardness. Ex vivo biopsy weight evaluations were conducted using chicken liver, gizzard, breast, and pork loin tissues. Furthermore, in vivo experiments were performed using murine subcutaneous tumor models. The modified method involved using a coaxial introducer needle to maintain a 1 cm notch length while employing a 2 cm stroke length to increase tissue yield. Biopsy performance parameters, including sample weight and DNA yield, were compared between the modified and conventional methods. The firing speed of the biopsy needles with 1 cm and 2 cm stroke lengths was also measured using a high-speed camera.

RESULTS

The modified technique significantly increased the sample volume across all agarose gel concentrations (9.5-13% increase, P < 0.05). Ex vivo tests revealed significantly higher tissue yields in most samples, except for chicken gizzards. In vivo, the modified method produced significantly larger tissue samples (4.6 mg vs. 2.9 mg, P < 0.001) and higher DNA yield (8.2 ng vs. 6.9 ng, P < 0.05). In addition, the biopsy needle's firing speed was 1.4-1.8 times faster with the 2 cm stroke length than 1 cm stroke.

CONCLUSION

The modified biopsy technique using a 2 cm stroke length significantly improved tissue yield, enhancing the quality of biopsy samples for molecular analyses in precision medicine.

CT-Guided Transthoracic Core-Needle Biopsy of Pulmonary Nodules: Current Practices, Efficacy, and Safety Considerations

CT-guided transthoracic core-needle biopsy (CT-TTNB) is a minimally invasive procedure that plays a crucial role in diagnosing pulmonary nodules. With high diagnostic yield and low complication rates, CT-TTNB is favored over traditional surgical biopsies, providing accuracy in detecting both malignant and benign conditions. This literature review aims to present a comprehensive overview of CT-TTNB, focusing on its indications, procedural techniques, diagnostic yield, and safety considerations. Studies published between 2013 and 2024 were systematically reviewed from PubMed, Web of Science, Scopus, and Cochrane Library using the SANRA methodology. The results highlight that CT-TTNB has a diagnostic yield of 85-95% and sensitivity rates for detecting malignancies between 92 and 97%. Several factors, including nodule size, lesion depth, needle passes, and imaging techniques, influence diagnostic success. Complications such as pneumothorax and pulmonary hemorrhage were noted, with incidence rates varying from 12 to 45% for pneumothorax and 4 to 27% for hemorrhage. Preventative strategies and management algorithms are essential for minimizing and addressing these risks. In conclusion, CT-TTNB remains a reliable and effective method for diagnosing pulmonary nodules, particularly in peripheral lung lesions. Advancements such as PET/CT fusion imaging, AI-assisted biopsy planning, and robotic systems further enhance precision and safety. This review emphasizes the importance of careful patient selection and procedural planning to maximize outcomes while minimizing risks, ensuring that CT-TTNB continues to be an indispensable tool in pulmonary diagnostics.

Diagnostic Accuracy and Safety of Nonsurgical Biopsy for Diagnosing Pulmonary Ground-Glass Opacities: A Systematic Review and Meta-Analysis

INTRODUCTION

Previous meta-analyses have explored the diagnostic accuracy and safety of computed tomography-guided percutaneous lung biopsy of ground-glass opacities (GGOs). However, no research investigated the role of nonsurgical biopsies (including transbronchial approaches). Additionally, studies reporting the diagnostic accuracy of GGOs with different characteristics are scarce, with no quantitative assessment published to date. We performed a systematic review to explore the diagnostic accuracy and safety of nonsurgical biopsy for diagnosing GGOs, especially those with higher ground-glass components and smaller nodule sizes.

METHODS

A thorough literature search of four databases was performed to compile studies evaluating both or either of the diagnostic accuracy and complications of nonsurgical biopsy for GGOs. A bivariate random-effects model and random-effect model were utilized for data synthesis. The methodological quality of the studies was assessed according to the Quality Assessment of Diagnostic Accuracy Studies-2 tool.

RESULTS

Nineteen eligible studies with a total of 1,379 biopsy-sampled lesions were analyzed, of which 1,124 were confirmed to be malignant. Nonsurgical biopsy reported a pooled sensitivity of 0.89, a specificity of 0.99, and a negative predictive value (NPV) of 60.3%. The overall sensitivity, specificity, and NPV of nonsurgical biopsy for diagnosing GGOs according to GGO component were 0.90, 0.99, and 77.2% in pure GGOs; 0.87, 0.99, and 67.2% in GG-predominant lesions; and 0.89, 1.00, and 44.1% in solid-predominant lesions, respectively. Additionally, the diagnostic sensitivity was better in lesions ≥20 mm than in small lesions (0.95 vs. 0.88). Factors that contributed to higher sensitivity were the use of a coaxial needle system and CT fluoroscopy but not the needle gauge. The summary sensitivity of core needle biopsy (CNB) was not significantly higher than fine needle aspiration (FNA) (0.92 vs. 0.84; p = 0.42); however, we found an increased incidence of hemorrhage in CNB compared with FNA (60.9 vs. 14.2%; p = 0.012).

CONCLUSION

Nonsurgical biopsy for diagnosing GGOs shows high sensitivity and specificity with an acceptably low risk of complications. However, negative biopsy results are unreliable in excluding malignancy, necessitating resampling or subsequent follow-up. The applicability of our study is limited due to significant heterogeneity, indirect comparisons, and the paucity of data on bronchoscopic approaches, restricting the generalizability of our findings to patients requiring transbronchial biopsies.

Safety and feasibility comparison between three different CT-guided localization techniques under systemic approach algorithm

INTRODUCTION

In the era of lung cancer screening, more and more sub-centimeter indeterminate lung lesions are being identified. It is difficult to approach these lesions and obtain tissue to confirm diagnosis. CT-guided navigation followed by surgical resection is the best way to overcome this difficulty. The aim of this study is to compare the safety and feasibility of wire and dye-tattoo CT-guided localization techniques.

MATERIALS AND METHODS

From September 2019 to August 2021, 418 patients who presented with single lung lesion and received single CT-guided localization were included in this study. Procedure details, navigation results, and related complications were compared.

RESULTS

For patients who received wire localization, majority (98.3 %) had perihilar lesions. In addition, 68 (57.1 %) patients received tangential approach because of lesions were blocked by bony or vital structure, abutting major fissure, or previous approach failure. The characteristics of lesion location was quite different than dye-tattooing technique (p = 0.033). As regards persistence of the target lesion localization, the interval between localization and surgery using ICG tattooing was 829.0 ± 552.9 min; much longer than the other two navigation techniques (p < 0.0001). As regards safety, patients who received wire localization had a higher rate of pneumothorax (p = 0.042) and pulmonary hemorrhage (p < 0.001) than the dye-tattooing techniques.

DISCUSSION

CT-guided navigation techniques are safe and feasible. Wire localization is suitable for centrally located lesions but the wire needs to be fixed properly and symptomatic pneumothorax monitored for. Dye-tattooing is more suitable for peripheral lesions, while ICG localization persists longer than other techniques.