Computed tomography-guided percutaneous needle biopsy of indeterminate pulmonary pathology: Efficacy of obtaining a diagnostic sample in immunocompetent and immunocompromised patients

Nishita Kothary, Jason Bartos, Gloria Hwang, Ruchika Dua, William Kuo, Lawrence Hofmann

Research output: Contribution to journalArticle

Abstract

Purpose: We aimed to evaluate the efficacy of computed tomography (CT)-guided percutaneous lung biopsy of pulmonary nodules with indeterminate radiologic characteristics in patients at risk for malignant and nonmalignant processes such as infection or inflammation. Patients and Methods: From January 2003 to September 2008, 262 patients (mean age, 59 years; range, 18-92 years) with pulmonary nodules or a mass of uncertain etiology and with indeterminate radiologic characteristics underwent CT-guided percutaneous lung biopsy. Patients with discordant clinical history and imaging findings or immunocompromised patients at risk for both etiologies were included. Specimens were submitted for both cytology and microbiology. Results: Of the entire cohort, 166 patients (63.4%) had a nonmalignant process, and 96 patients (36.6%) had a malignancy. CT-guided percutaneous lung biopsy established a diagnosis in 166 patients (63.4%). Of the 166 patients with a nonmalignant etiology and 96 patients with malignancy, it provided a definitive diagnosis in 91 patients (54.8%) and 75 patients (78.1%), respectively, a difference that was statistically significant (P = .0001). Overall diagnostic efficacy between immunocompetent and immunocompromised patients was comparable (P = .2); however, detection of infection or inflammation in individual groups was lower compared with detection of malignancy (P = .002 and P = .06, respectively). Conclusion: CT-guided percutaneous lung biopsy in patients who are clinically at risk for both nonmalignant and malignant processes continues to be a challenge. Although CT-guided percutaneous biopsy can establish an accurate diagnosis in a large majority of patients with malignancy, it is significantly less sensitive for infectious or inflammatory processes.

Original languageEnglish (US)
Pages (from-to)251-256
Number of pages6
JournalClinical Lung Cancer
Volume11
Issue number4
DOIs
StatePublished - Jul 1 2010
Externally publishedYes

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Immunocompromised Host
Needle Biopsy
Tomography
Pathology
Lung
Biopsy
Neoplasms
Inflammation
Microbiology
Infection
Cell Biology

Keywords

  • Fine needle aspiration
  • Inflammation
  • Mycobacterial infection
  • VATS

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Computed tomography-guided percutaneous needle biopsy of indeterminate pulmonary pathology : Efficacy of obtaining a diagnostic sample in immunocompetent and immunocompromised patients. / Kothary, Nishita; Bartos, Jason; Hwang, Gloria; Dua, Ruchika; Kuo, William; Hofmann, Lawrence.

In: Clinical Lung Cancer, Vol. 11, No. 4, 01.07.2010, p. 251-256.

Research output: Contribution to journalArticle

Kothary, Nishita ; Bartos, Jason ; Hwang, Gloria ; Dua, Ruchika ; Kuo, William ; Hofmann, Lawrence. / Computed tomography-guided percutaneous needle biopsy of indeterminate pulmonary pathology : Efficacy of obtaining a diagnostic sample in immunocompetent and immunocompromised patients. In: Clinical Lung Cancer. 2010 ; Vol. 11, No. 4. pp. 251-256.
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abstract = "Purpose: We aimed to evaluate the efficacy of computed tomography (CT)-guided percutaneous lung biopsy of pulmonary nodules with indeterminate radiologic characteristics in patients at risk for malignant and nonmalignant processes such as infection or inflammation. Patients and Methods: From January 2003 to September 2008, 262 patients (mean age, 59 years; range, 18-92 years) with pulmonary nodules or a mass of uncertain etiology and with indeterminate radiologic characteristics underwent CT-guided percutaneous lung biopsy. Patients with discordant clinical history and imaging findings or immunocompromised patients at risk for both etiologies were included. Specimens were submitted for both cytology and microbiology. Results: Of the entire cohort, 166 patients (63.4{\%}) had a nonmalignant process, and 96 patients (36.6{\%}) had a malignancy. CT-guided percutaneous lung biopsy established a diagnosis in 166 patients (63.4{\%}). Of the 166 patients with a nonmalignant etiology and 96 patients with malignancy, it provided a definitive diagnosis in 91 patients (54.8{\%}) and 75 patients (78.1{\%}), respectively, a difference that was statistically significant (P = .0001). Overall diagnostic efficacy between immunocompetent and immunocompromised patients was comparable (P = .2); however, detection of infection or inflammation in individual groups was lower compared with detection of malignancy (P = .002 and P = .06, respectively). Conclusion: CT-guided percutaneous lung biopsy in patients who are clinically at risk for both nonmalignant and malignant processes continues to be a challenge. Although CT-guided percutaneous biopsy can establish an accurate diagnosis in a large majority of patients with malignancy, it is significantly less sensitive for infectious or inflammatory processes.",
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