CT-guided biopsy of lung nodules with pleural contact: Comparison of two puncture routes

Purpose: The purpose of this study was to retrospectively compare two puncture routes (transpleural vs. transpulmonary) for computed tomography (CT) fluoroscopy-guided cutting needle biopsy of lung nodules with pleural contact. Patients and methods: A total of 102 patients (72 men; mean age, 71.1 +/- 9.5 [ SD] years) were included and 102 biopsies of 102 lung nodules (mean size, 16.7 +/- 5.9 [ SD] mm; range, 6.0-29.4 mm; mean length of pleural contact, 10.1 +/- 4.2 [ SD] mm; range, 2.8-19.6 mm) were analyzed. All procedures were classified as biopsies via the direct transpleural route or the transpulmonary route. The patient-, lesion-, and biopsy-related variables, diagnostic yields, and incidence of complications were compared between the two routes. Results: Biopsy was performed via the direct transpleural route (n= 59; 57.8%) and transpulmonary route (n= 43; 42.2%). In the transpulmonary route group, the mean distance of the intrapulmonary pathway was 17.7 +/- 9.4 [SD] mm (range: 4.1-47.6 mm; P < 0.001) and the introducer needle trajectory angle of < 45 degrees was significantly observed (8.5% [5/59] vs. 60.5% [26/43]; P < 0.001). There was no significant difference in diagnostic accuracy between the direct transpleural and transpulmonary routes (93.2% [55/59] vs. 90.7% [39/43]; P = 0.718). The frequencies of all complications (64.4% [38/59] vs. 97.7% [42/43]; P< 0.001), pneumothorax (33.9% [20/59] vs. 65.1% [28/43]; P = 0.003), pneumothorax with chest tube placement (3.4% [2/59] vs. 18.6% [8/43]; P = 0.016), and pulmonary hemorrhage (47.5% [28/59] vs. 76.7% [33/43]; P= 0.004) were significantly lower in the direct transpleural group. Conclusion: Direct transpleural route is recommended for CT fluoroscopy-guided biopsy of lung nodules with pleural contact because it is safer and yields similar diagnostic accuracy than transpulmonary route. (C) 2021 Societe francaise de radiologie. Published by Elsevier Masson SAS. All rights reserved.

Automated summary

This study retrospectively compared two puncture routes for CT fluoroscopy-guided cutting needle biopsy of lung nodules and found that the direct transpleural route is safer and yields similar diagnostic accuracy compared to the transpulmonary route.