Jaconi Marta, Pagni Fabio, Vacirca Francesco, Leni Davide, Corso Rocco, Cortinovis Diego, Bidoli Paolo, Bono Francesca, Cuttin Maria S, Valente Maria G, Pesci Alberto, Bedini Vittorio A, Leone Biagio E
From the Department of Pathology (MJ, FP, FB, MSC, MGV), University Milan Bicocca; Department of Radiology (FV, DL, RC); Department of Oncology (DC, PB); Department of Health Sciences (AP), Pneumology Unit, University Milan Bicocca; Department of Thoracic Surgery (VB), San Gerardo Hospital, Monza; and Department of Pathology (BEL), Desio Hospital, University Milan Bicocca, Desio, Italy.
Medicine (Baltimore). 2015 Mar;94(12):e698. doi: 10.1097/MD.0000000000000698.
C-arm cone-beam computed tomography (CT)-guided transthoracic lung core needle biopsy (CNB) is a safe and accurate procedure for the evaluation of patients with pulmonary nodules. This article will focus on the clinical features related to CNB in terms of diagnostic performance and complication rate. Moreover, the concept of categorizing pathological diagnosis into 4 categories, which could be used for clinical management, follow-up, and quality assurance is also introduced. We retrospectively collected data regarding 375 C-arm cone-beam CT-guided CNBs from January 2010 and June 2014. Clinical and radiological variables were evaluated in terms of success or failure rate. Pathological reports were inserted in 4 homogenous groups (nondiagnostic--L1, benign--L2, malignant not otherwise specified--L3, and malignant with specific histotype--L4), defining for each category a hierarchy of suggested actions. The sensitivity, specificity, and positive and negative predictive value and accuracy for patients subjected to CNBs were of 96.8%, 100%, 100%, 100%, and 97.2%, respectively. Roughly 75% of our samples were diagnosed as malignant, with 60% lung adenocarcinoma diagnoses. Molecular analyses were performed on 85 malignant samples to verify applicability of targeted therapy. The rate of "nondiagnostic" samples was 12%. C-arm cone-beam CT-guided transthoracic lung CNB can represent the gold standard for the diagnostic evaluation of pulmonary nodules. A clinical and pathological multidisciplinary evaluation of CNBs was needed in terms of integration of radiological, histological, and oncological data. This approach provided exceptional performances in terms of specificity, positive and negative predictive values; sensitivity in our series was lower compared with other large studies, probably due to the application of strong criteria of adequacy for CNBs (L1 class rate). The satisfactory rate of collected material was evaluated not only in terms of merely diagnostic performances but also for predictive results by molecular analysis.
C形臂锥形束计算机断层扫描（CT）引导下的经胸肺芯针活检（CNB）是评估肺结节患者的一种安全、准确的方法。本文将从诊断性能和并发症发生率方面重点关注与CNB相关的临床特征。此外，还介绍了将病理诊断分为4类的概念，这可用于临床管理、随访和质量保证。我们回顾性收集了2010年1月至2014年6月期间375例C形臂锥形束CT引导下CNB的相关数据。根据成功率评估临床和放射学变量。将病理报告分为4个同质组（非诊断性——L1、良性——L2、未另行指定的恶性——L3和具有特定组织学类型的恶性——L4），为每个类别定义建议行动的层次结构。接受CNB的患者的敏感性、特异性、阳性和阴性预测值以及准确率分别为96.8%、100%、100%、100%和97.2%。我们大约75%的样本被诊断为恶性，其中60%为肺腺癌诊断。对85个恶性样本进行了分子分析，以验证靶向治疗的适用性。“非诊断性”样本的比例为12%。C形臂锥形束CT引导下的经胸肺CNB可成为肺结节诊断评估的金标准。就放射学、组织学和肿瘤学数据的整合而言，需要对CNB进行临床和病理多学科评估。这种方法在特异性、阳性和阴性预测值方面表现出色；与其他大型研究相比，我们系列中的敏感性较低，这可能是由于对CNB采用了严格的充分性标准（L1类比例）。不仅根据单纯的诊断性能，还根据分子分析的预测结果评估所收集材料的满意率。
