Demetris Andrea Patsios BMBCH, FRCR, Presenter: Nothing to Disclose

Heidi Roberts, Abstract Co-Author: Nothing to Disclose

Narinder S. Paul MD, Abstract Co-Author: Nothing to Disclose

Taebong Chung MD, Abstract Co-Author: Nothing to Disclose

Stephen Jay Herman MD, Abstract Co-Author: Nothing to Disclose

Gordon Weisbrod MD, Abstract Co-Author: Nothing to Disclose

Andre Pereira MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

With improved detection of small pulmonary nodules there is demand for sampling small lesions using CT guided percutaneous fine needle aspiration biopsies (FNAB) in order to accurately differentiate between benign and malignant nodules. The aim of this study is to determine the value of FNAB of small pulmonary nodules measuring 10 mm or less.

Retrospective study of 32 FNAB performed in our institution between 01/2003 and 12/2004. All were performed on a 4-row CT scanner (Asteion, Toshiba Medical Systems, Japan or Lightspeed, General Electric Medical System, Milwaukee, WI). A coaxial technique was used with an outer Bard Truguide coaxial needle 19G (C.R. Bard, Inc., GA) and an inner disposable Greene Biopsy Needle 22G (Cook Inc., IL). We recorded the size of the sampled lesions, their distance from the pleura, the number of pleural punctures and fine needle aspirates (FNA), the complications encountered, the cytological diagnosis and the outcome in all the cases.

32 FNABs were performed in 18 men and 14 women, average age 63 years (range 38-82 years). One case is excluded because the outcome is not yet known. 7 nodules measured 5-8 mm and 24 nodules 9-10mm. The average distance from the costal pleura was 34 mm (range 0-72mm). In 26 of the 31 FNABs, the pleura was crossed once. An average of 4 FNA’s was performed per case (range 1-7). 18 of the 31 cases had no complications, 13 had a pneumothorax, 1 required a chest drain insertion. The rate of complications (41%) in this subgroup is higher than the average encountered in our institution (27%). 19 of the 31 FNABs (61%) were adequate for diagnosis, of which 14 were malignancies. In 7 cases (23%), where no definite diagnosis was made following FNAB, the outcome has not been affected. In 5 cases (16%), samples were insufficient for diagnosis or negative and were diagnosed as neoplastic subsequently. The sensitivity for malignancy was 74% and our overall accuracy was 84%.

CT guided FNAB is a useful tool in the diagnosis and management of subcentimetre pulmonary nodules, even though the sensitivity for neoplasia, and the overall accuracy is lower than that of larger sampled pulmonary lesions.

Patsios, D, Roberts, H, Paul, N, Chung, T, Herman, S, Weisbrod, G, Pereira, A, et al, , CT-guided Percutaneous Fine Needle Aspiration Biopsy of Subcentimeter Intrapulmonary Nodules.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4407723.html