Diagnostic accuracy and complications of CT-guided core needle lung biopsy of solid and part-solid lesions

Objective: To evaluate whether diagnostic accuracy and complications of CT-guided core needle biopsy (CNB) differ for solid and part-solid lung lesions Methods: This retrospective study included 354 consecutive patients from April 2012 to July 2016 who underwent CT-guided CNB of lung lesions by a radiologist. Patient demographics, lung lesions' characteristics; solid or part-solid, underlying pulmonary disease, distance of path, procedure time, complications (hemorrhage or pneumothorax), histopathological results of biopsy specimens and final diagnosis were reviewed. The diagnostic yields, biopsy-related factors and complications were compared for patients with solid lesions and patients with part-solid lesions. Factors related to true diagnoses and complications were analyzed statistically. Results:The biopsies of part-solid lesions take more time (p = 0.021). Non-diagnostic biopsies were not statistically different between solid and part-solid lesions (p = 0.804). There was no significant difference in the diagnostic yields including sensitivity, specificity, accuracy, positive predictive value and negative predictive value for solid and part-solid lesions statistically. The occurrence of hemorrhage on postbiopy follow-up CT was significantly higher (p = 0.016) for part-solid lesions. The occurrence of symptomatic major hemorrhage (p = 0.859) and pneumothorax (p = 0.106) was not significantly different between solid and part-solid lesions. Conclusion: The diagnostic accuracy of CT-guided CNB for diagnosing malignancy was comparable for solid and part-solid lesions. The frequency of hemorrhage on the follow up CT was higher in patients with part-solid lesions, but there were no significant differences in major hemorrhage and pneumothorax for solid and part-solid lesions. Advances in knowledge: The diagnostic yield of CT-guided CNB for diagnosing malignancy is comparable for solid and part-solid lesions. Although the post procedural hemorrhage occurs more frequently in part-solid lesions, the occurrence of symptomatic major hemorrhage is not significantly different. Therefore, CT-guided CNB should be considered for histopathological confirmation of intrapulmonary lesions regardless of the presence of ground-glass opacity portion.