CT-Guided Biopsy of Lesions of the Lung, Liver, Pancreas or of Enlarged Lymph Nodes

Rationale and Objectives

To assess the value of additional fine needle aspiration (FNA) to core needle biopsy (CNB) in computed tomography–guided biopsy of lesions of the lung, liver, pancreas, or of enlarged lymph nodes in an offsite cytopathologist setting.

Materials and Methods

This retrospective Health Insurance Portability and Accountability Act–compliant study was approved by the Institutional Review Board (IRB); informed consent (IC) was waived. Data of 377 patients who underwent computed tomography–guided FNA and CNB of lesions of the lung, liver, pancreas, or enlarged lymph nodes were enrolled. An onsite cytopathologist was not available. Sensitivity and specificity were calculated for FNA, CNB, and combined FNA/CNB. For the purpose of our study, positive diagnoses from CNB specimens or subsequent biopsy or surgical resection specimens or clinical follow-up data were considered as the standard of reference.

Results

CNB yielded a significantly higher sensitivity than FNA in all sites, except the pancreas, where the difference did not reach statistical significance. Additional FNA to CNB did not significantly increase the sensitivity. Specificity did not significantly differ between FNA, CNB, and combined FNA/CNB in all sites. Malignancies of 1.7% were detected only with FNA, without evidence of malignancy in CNB; for the remaining malignancies, CNB was positive or indeterminate.

Conclusion

Additional FNA to CNB without an onsite cytopathologist does not yield higher sensitivity or specificity compared to CNB alone.

Computed tomography (CT)-guided needle biopsy of thoracic and abdominal lesions has become a well-established diagnostic procedure in patients with indeterminate imaging findings and in patients with known or suspected malignancies who are planned for operation, chemotherapy, or radiotherapy. CT-guided lung biopsies are often performed with fine needle aspiration (FNA) for cytology . More recently, core needle biopsy (CNB) with cutting needle technology was implemented, which allowed a histological evaluation of lesions . In efforts to improve the diagnostic ability of lung biopsy, several authors stated that the use of CNB after negative FNA was helpful . Although it may appear that cytological and histological examination will also be complementary in the assessment of abdominal lesions, there are conflicting data in the literature with regard to the accuracy and usefulness of combining these techniques . In particular, there are wide variations in the reported diagnostic sensitivities of FNA and CNB. Both techniques are very safe; however, FNA is often preferred in the biopsy of deeply placed lesions, sites adjacent to major vessels, or in cases when the needle has to pass through the bowel to reach the lesion. The decision to use FNA or CNB may also be influenced by the experience of the interventional radiologist and the availability of a cytopathologist for onsite assessment of the specimens. The advantage of CNB includes the preservation of tissue architecture of the specimen, which may be important in the assessment and subtyping of some tumors and the possibility of performing immunohistochemical techniques; the advantage of FNA includes the use of very thin needles with 20–22 gauges and the quick report.

The aim of this study is to evaluate whether the additional use of FNA to CNB improves the accuracy of the CT-guided biopsy of lesions of the lung, liver, pancreas, or of enlarged lymph nodes, in an offsite pathologist setting.

Materials and methods

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Results

Lung

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Table 1

Sensitivity and Specificity of FNA, CNB, and Combined FNA/CNB for Different Tumor Sites

FNA CNB FNA/CNB Lung Sensitivity 64.7%

(0.561–0.727) 91.2%

(0.851– 0.954) 94.9%

(0.897–0.979) Specificity 95.7%

(0.852–0.995) 93.5%

(0.821–0.986) 91.3%

(0.792–0.976) Liver Sensitivity 58.8%

(0.476–0.694) 89.4%

(0.808–0.950) 90.6%

(0.823–0.958) Specificity 100%

(0.832–1.000) 95%

(0.751–0.999) 95.0%

(0.751–0.999) Pancreas Sensitivity 75.0%

(0.588–0.873) 82.5%

(0.672–0.927) 87.5%

(0.732–0.958) Specificity 100%

(0.478–1.000) 100%

(0.478–1.000) Lymph nodes Sensitivity 57.9%

(0.408–0.737) 97.4%

(0.863–0.999) 97.4%

(0.862–0.999) Specificity 71.4%

(0.290–0.963) 100%

(0.590–1.000) 71.4%

(0.290–0.963)

FNA, fine-needle aspiration; CNB, core needle biopsy.

Numbers in parentheses represent 95% confidence limits.

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Table 2

Comparison of Fine-Needle-Aspiration (FNA) and Core-Biopsy (CNB) of Lung Lesions

CNB Negative Positive Indeterminate Differentiation ∗ Precision † FNA Negative ‡ 47 (4) 40 (40) 4 (2) Positive 3 (2) 57 (57) 3 (3) Indeterminate 0 1 (1) 1 (1) Differentiation ∗ 14 (14) Precision † 12 (12)

Numbers in parentheses represent rates of malignancies.

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Liver

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Table 3

Comparison of Fine-Needle-Aspiration (FNA) and Core-Biopsy (CNB) of Liver Lesions

CNB Negative Positive Indeterminate Differentiation ∗ Precision † FNA Negative ‡ 27 (8) 27 (27) 1 Positive 1 (1) 40 (40) 0 Indeterminate 0 0 0 Differentiation ∗ 1 (1) Precision † 8 (8)

Numbers in parentheses represent rates of malignancies.

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Pancreas

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Table 4

Comparison of Fine-Needle-Aspiration (FNA) and Core-Biopsy (CNB) of Lesions within the Pancreas

CNB Negative Positive Indeterminate Differentiation ∗ Precision † FNA Negative ‡ 9 (4) 4 (4) 1 (1) Positive 2 (2) 25 (25) 0 Indeterminate 0 1 (1) 0 Differentiation ∗ 0 Precision † 3 (3)

Numbers in parentheses represent rates of malignancies.

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Lymph Nodes

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Table 5

Comparison of Fine-Needle-Aspiration (FNA) and Core-Biopsy (CNB) of Enlarged Lymph Nodes

CNB Negative Positive Indeterminate Differentiation ∗ Precision † FNA Negative ‡ 6 (1) 14 (14) 0 Positive 1 16 (16) 0 Indeterminate 1 1 (1) 0 Differentiation ∗ 1 (1) Precision † 5 (5)

Numbers in parentheses represent rates of malignancies.

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Discussion

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References

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CT-Guided Biopsy of Lesions of the Lung, Liver, Pancreas or of Enlarged Lymph Nodes

Rationale and Objectives

Materials and Methods

Results

Conclusion

Materials and methods

Results

Lung

Liver

Pancreas

Lymph Nodes

Discussion

References

Further Reading

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