Complications and diagnostic accuracy of CT-guided 18G tru-cut versus end-cut percutaneous core needle biopsy of solitary solid lung nodules

Abstract

PURPOSE Percutaneous biopsy has demonstrated a high accuracy in the diagnosis of lung nodules, but the technique is not innocuous and a yield decrease in lesions smaller than 20 mm has been reported. We carried out a prospective study to evaluate and compare the complications and effectiveness of percutaneous core needle biopsy (CNB) of solitary solid lung nodules, which was performed with 2 types of automatic guns. METHODS A total of 330 consecutive CT-guided CNBs were included. Tru-cut or end-cut 18G devices were used alternatively. Nodules were categorized by their size: <= 10 mm, 11-20 mm, and >20 mm. Incidence of complications such as pneumothorax or hemoptysis and factors influencing them (nodule size and depth within lung parenchyma) were evaluated. Diagnostic accuracy of CNB achieved in nodules of different size categories with the 2 different needles were calculated, statistically evaluated, and compared. RESULTS We performed 68 CNBs in nodules <= 10 mm, 130 in nodules 11-20 mm, and 132 in nodules >20 mm. Pneumothorax appeared in 24.2% of them, but only 5.7% required drainage. Hemoptysis developed in 9.4%, and abundant hemoptysis with hypoxemia was observed in only 4.2% of patients. Regarding appearance of complications between the 2 needle types, no significant differences were found. A higher risk of hemoptysis was observed in nodules <= 10 mm (odds ratio [OR], 3.87; 95% CI, 1.24-12.06; P =.019) and in those located deeper in the pulmonary parenchyma (OR, 2.21; 95% CI, 1.04-4.69, P =.038). End- cut needles reached a diagnostic accuracy of 93.7%, 92.1%, and 98.3%, in nodules sized <= 10 mm, 11-20 mm, and >20 mm, respectively. Corresponding results for tru- cut were 84.7%, 88.5%, and 92.1%. In spite of differences reaching up to 9% in smaller nodules, intragroup results were not significant. CONCLUSION Both needles have a similar complication rate. Although statistically significant differences between the 2 types of needles were not observed, end-cut devices have demonstrated a higher diagnostic yield in all 3 size categories of nodules and could be a more suitable option, especially for CNB of nodules <= 10 mm.