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Image-guided 25-gauge Needle Biopsy for Thoracic Lesions: Diagnostic Feasibility and Safety¹

¹ From the Department of Radiology, Dana Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, 44 Binney St, Boston, MA 02115 (E.v.S.); Department of Radiology, University of British Columbia, Vancouver, Canada (B.W.G.); Alliance Radiology Consultants, Bayshore Medical, Pasadena, Tex (G.R.W.); Departments of Pathology (R.L.) and Surgery (J.B.Z.), University of Texas Medical Branch, Galveston; and Department of Radiology, Royal Victoria Hospital, Belfast, Northern Ireland (P.T.K.). Received August 22, 2001; revision requested October 17; revision received August 15, 2002; accepted September 30. Address correspondence to E.v.S. (e-mail: evansonnenberg@partners.org).

PURPOSE: To report our experience regarding the feasibility and safety of 25-gauge needles for biopsy of thoracic lesions.

MATERIALS AND METHODS: Twenty-six patients with thoracic lesions, predominately pulmonary nodules, measuring 0.7–5.2 cm (mean, 1.6 cm) underwent biopsy with computed tomographic (n = 24), ultrasonographic (n = 1), or fluoroscopic (n = 1) guidance. Nineteen patients had severe chronic obstructive pulmonary disease (COPD), one had severe restrictive lung disease, and one had a coagulopathy; the other five patients had nonpulmonary primary tumors. Biopsy with an inner 25-gauge needle traversing an outer extrapleural coaxial cannula was performed in all patients. Cytologic quick staining was performed routinely to determine specimen adequacy and to establish a preliminary diagnosis. Complications, specimen adequacy, and need for larger specimens were evaluated.

RESULTS: Adequate specimens (as determined by cytopathologists) were obtained in 24 (92%) of 26 patients, with a definitive diagnosis achieved in 23 (88%) patients during initial quick staining (17 malignant and six benign diagnoses). Two cases initially considered suspicious for malignancy were reclassified as benign (thymoma and histoplasmosis). At the request of cytopathologists, a larger needle was used to supplement the 25-gauge needle in six patients: In one patient, it provided further diagnostic information; in four, it did not; and in one, it confirmed non-Hodgkin lymphoma. Five patients developed a small pneumothorax (<10%) with use of the 25-gauge needle alone; one other patient, in whom larger needles were placed, received a radiologic chest catheter to evacuate the pneumothorax, thereby allowing the biopsy to continue.

CONCLUSION: Image-guided 25-gauge needle biopsy is both feasible and safe.

© RSNA, 2003

Index terms: Biopsies, complications, 66.739 • Biopsies, technology, 60.126 • Thorax, biopsy, 60.126 • Thorax, neoplasms, 60.314, 60.321

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