Data from: Efficacy and safety of CT-guided percutaneous fine needle aspiration and biopsy for malignant pulmonary lesions

Background: CT guided percutaneous transthoracic fine needle aspiration
(FNA) and core biopsy (CB) are commonly used to characterise lung lesions.
There is conflicting information on which method is superior and wide
variation in reported complication rates. Objectives: Our objectives were
to establish the efficacy and safety of percutaneous CT guided FNA and CB
in the diagnosis of malignant lung lesions. Methods: This retrospective
study included patients who underwent CT guided percutaneous FNA and/or CB
for lung parenchymal lesions at Kasturba Medical College Mangalore from
January 2013 to December 2020. Ethical clearance was obtained from the
Institutional Ethics Committee. Efficacy was determined by the adequacy of
samples, sensitivity, specificity and diagnostic accuracy. Safety was
assessed using the incidence of complications. Results: 326 patients
underwent both FNA and CB, and 49 underwent FNA alone. Adequate samples
were obtained in 82.9% of FNA cases and 95.7% of CB cases. Considering
biopsy as the gold standard, the sensitivity, specificity and diagnostic
accuracy of FNA for malignancy were 95.19%, 80% and 91.27%, respectively.
Kappa agreement between the two methods was substantial (0.767).
Pneumothorax was the only complication observed, and was seen in 31
patients (8.2%), of which only one required chest tube drainage. The
incidence of pneumothorax was significantly higher in patients with
pre-existing lung disease such as COPD/emphysema (p value 0.000), patients
with smaller lesions (p = 0.009), and deeper lesions from the pleura (p
<0.0001). Conclusions: FNA and CB are both safe and effective
procedures. In the absence of an onsite cytopathologist, we recommend a
combination of both techniques.