Azadeh Khalatbari MSc, Presenter: Nothing to Disclose

Subhapradha Anand MBBS, MD, Abstract Co-Author: Nothing to Disclose

Jean M. Seely MD, Abstract Co-Author: Nothing to Disclose

Hamid Bayanati MD, Abstract Co-Author: Nothing to Disclose

Raghvendra K. Malghan MBBS, MD, Abstract Co-Author: Nothing to Disclose

Carolina Althoff Souza MD, Abstract Co-Author: Nothing to Disclose

To compare sensitivity, specificity and diagnostic accuracy of transthoracic fine needle aspiration (FNAB) and core needle biopsy (CNB) in the diagnosis of pure or semisolid ground glass nodules.

The images of 800 consecutive patients who underwent CT or fluoroscopic guided needle biopsy of pulmonary nodules from 2003 to 2008 were retrospectively reviewed for the presence of pure ground glass opacity (GGO) or semisolid nodules (>50% GGO). Cases with surgical excision, non surgical treatment or follow up CT of at least 2 years were included. From a total of 40 patients with 54 biopsies, cases were divided into 3 groups: Group 1 - FNAB only (n=37), Group 2 - CNB only (n=17) and group 3 - both FNAB and CNB (n=38). The sensitivity, specificity and diagnostic accuracy of each of the 3 groups were measured and compared using Fisher’s exact test.

In group 1 (FNAB only), malignancy was diagnosed in 30 cases (81%) with 30 true positive (TP). Benign lesions were diagnosed in 7 cases (19%) with 3 false negative (FN), giving a sensitivity of 91% and specificity of 100%. In group 2 (CNB only), 9 biopsies were positive for malignancy (60%) giving 9 TP and 6 reports showed benign lesions (40%) with 3 FN. The sensitivity and specificity in group 2 was 75% and 100%, respectively. In Group 3, 33 biopsies were positive for malignancy (87%) with 33 TP and 5 biopsies showed benign pathologies (13%) with 1 FN. This gave a sensitivity of 97% and specificity of 100%. Total CNB combined in group 2 and group 3 showed sensitivity of 73% and specificity of 100%. Diagnostic accuracy of needle biopsy for diagnosing of GGO was 92% in group 1, 80% in group 2 and 97% in group 3. The sensitivity of group 2 was significantly lower than those of 1 and group 3 (p=0.047), however this difference was not significant between group 1 and group 3 (p>0.05). There was no significance difference in specificity and diagnostic accuracy among three groups (p>0.05).

Image guided FNAB is a highly sensitive and specific technique for diagnosing GGO lesions. Because of its high diagnostic accuracy, it can be used as an alternative to surgical and core biopsies.   

Percutaneous biopsy is highly accurate in the diagnosis of GGO lesions and FNAB alone is often diagnostic, precluding the need of core or surgical biopsy.

Khalatbari, A, Anand, S, Seely, J, Bayanati, H, Malghan, R, Souza, C, Comparative Study of Accuracy of Fine Needle Aspiration versus Core Needle Percutaneous Biopsy in the Diagnosis of Ground-glass Nodules.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8015993.html