Computed tomography-guided core needle biopsy for sub-centimeter pulmonary nodules

Introduction
Based on the computed tomography (CT) pulmonary nodules (PNs) screening trial, sub-centimeter PNs (SCPNs) with a diameter  10 mm are observed in approximately 15% of the screened population, of which 48–56% of the cases occur in patients with lung cancer.

Aim
To assess the safety and diagnostic precision of CT-guided core needle biopsy (CNB) for SCPNs.

Material and methods
Between January 2016 and December 2018, consecutive patients with PNs underwent a CT-guided CNB procedure. These patients were divided into 2 groups. Group A included patients with SCPNs and group B included patients with PNs of 11–20 mm in diameter. The baseline data, diagnostic performance, and complication rates were compared.

Results
The technical success rates of CT-guided CNB in groups A and B were both 100%. No statistically significant differences were observed in diagnostic yield (43.8% vs. 54.7%, p = 0.105), overall accuracy (89.5% vs. 94.0%, p = 0.221), and sensitivity (78.8% vs. 90.1%, p = 0.080) between the 2 groups. The independent risk factor related to diagnostic failure of SCPNs was CNB-related pneumothorax (p = 0.001). There were no significant differences in the rates of pneumothorax (13.3% vs. 15.4%, p = 0.664) and pulmonary hemorrhage (10.5% vs. 8.5%, p = 0.624) between the 2 groups. The risk factors related to pneumothorax were decubitus position (p = 0.009) and more needle pathways (p = 0.004). A risk factor associated with pulmonary hemorrhage was greater lesion-pleura distance (p = 0.048).

Conclusions
CT-guided CNB is a safe, reliable, and precise method for the diagnosis of SCPNs.