CT-Guided Fine-Needle Aspiration Biopsy of Pulmonary Nodules 8 mm or Less Has a Higher Diagnostic Accuracy than Positron Emission Tomography-CT

Purpose: To compare diagnostic accuracy of CT-guided fine-needle aspiration biopsy (FNA-B) with positron emission tomography (PET)-CT for pulmonary nodules = 8 mm. Materials and Methods: A retrospective review of all CT-guided lung FNA-Bs performed between 2011 and 2014 at a single institution was undertaken to evaluate patients who had FNA-B and PET-CT imaging of nodules of = 8 mm. Patients without surgical pathology or 2-year follow-up CT scans were excluded. Of 1,896 patients, 41 patients with 43 subcentimeter pulmonary nodules met study criteria. The McNemar test was used to compare FNA-B with PET-CT results. Results: FNA-B had a sensitivity and diagnostic accuracy of 88.9% and 81.4%, respectively. PET-CT had an overall sensitivity and diagnostic accuracy of 38.9% and 46.5%, respectively. FNA-B had a significantly higher sensitivity and diagnostic accuracy for malignant nodules compared with PET-CT (P < .001). Pneumothorax rate after FNA-B was 13.9%, and chest tube insertion rate was 0%. Conclusions: FNA-B is a safe procedure with superior sensitivity and higher diagnostic accuracy compared with PET-CT in pulmonary nodules <= 8mm in size.