Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea.
Department of Radiology, Konkuk University Medical Center, Seoul, Korea.
Eur Radiol. 2021 Dec;31(12):9000-9011. doi: 10.1007/s00330-021-08038-x. Epub 2021 May 18.
To determine the accuracy of CT-guided percutaneous transthoracic needle lung biopsy (PTNB) for the diagnosis of malignancy and the associated complication rates in patients with idiopathic pulmonary fibrosis (IPF).
This retrospective study included 91 CT-guided PTNBs performed in 80 patients with IPF from April 2003 through December 2016. Data regarding patients, target lesions, procedures, complications, and pathological reports were collected, and the final diagnosis was made. The diagnostic accuracy, sensitivity, specificity, percentage of nondiagnostic results, and complication rates were determined. Multivariable logistic regression analyses were performed to identify risk factors for nondiagnostic results and major complications.
Three biopsies (technical failure [n = 2] and undetermined final diagnosis [n = 1]) were excluded from the diagnostic accuracy calculation. The diagnostic accuracy, sensitivity, and specificity were 89% (78/88), 90% (62/69), and 84% (16/19), respectively. The percentage of nondiagnostic results was 34% (30/88). Lesion size ≤ 3 cm (odds ratio [OR], 8.8; 95% confidence interval [CI], 2.5-31.2; p = 0.001) and needle tip placement outside the target lesion (OR, 13.7; 95% CI, 1.4-132.2; p = 0.02) were risk factors for nondiagnostic results. The overall and major complication rates were 51% (46/91) and 12% (11/91), respectively. The presence of honeycombing along the path of the needle (OR, 11.2; 95% CI, 1.4-89.1; p = 0.02) was an independent risk factor for major complications.
CT-guided PTNB shows a relatively reasonable accuracy in diagnosing malignancy in patients with IPF. The complication rate may be high, especially when the needle passes through honeycomb lesions.
• In patients with idiopathic pulmonary fibrosis (IPF), CT-guided percutaneous transthoracic needle lung biopsy (PTNB) showed a relatively reasonable accuracy for the diagnosis of malignancy. • Target lesion size ≤ 3 cm and biopsy needle tip placement outside the target lesion were risk factors for nondiagnostic results of CT-guided PTNB. • The complication rate may be high, especially in cases where the biopsy needle passes through honeycomb lesions.
确定 CT 引导经皮经胸肺穿刺活检（PTNB）在特发性肺纤维化（IPF）患者中诊断恶性肿瘤的准确性及其相关并发症发生率。
本回顾性研究纳入了 2003 年 4 月至 2016 年 12 月间 80 例 IPF 患者的 91 例 CT 引导 PTNB。收集了有关患者、靶病变、操作、并发症和病理报告的数据，并做出最终诊断。确定了诊断准确性、敏感度、特异度、非诊断结果的百分比和并发症发生率。采用多变量逻辑回归分析确定非诊断结果和主要并发症的危险因素。
3 例（技术失败 2 例和最终诊断不确定 1 例）活检被排除在诊断准确性计算之外。诊断准确性、敏感度和特异度分别为 89%（78/88）、90%（62/69）和 84%（16/19）。非诊断结果的百分比为 34%（30/88）。病变大小≤3cm（比值比 [OR]，8.8；95%置信区间 [CI]，2.5-31.2；p=0.001）和针尖位于靶病变外（OR，13.7；95%CI，1.4-132.2；p=0.02）是导致非诊断结果的危险因素。总的和主要并发症发生率分别为 51%（46/91）和 12%（11/91）。针道存在蜂窝状结构（OR，11.2；95%CI，1.4-89.1；p=0.02）是主要并发症的独立危险因素。
CT 引导 PTNB 对 IPF 患者恶性肿瘤的诊断具有相对合理的准确性。并发症发生率可能较高，特别是当活检针穿过蜂窝状病变时。
