Imaging-guided Percutaneous Core-Needle Biopsy of Central Pulmonary Masses with Atelectasis: Comparison of The CT Versus the Ultrasound-Guided Procedures

Abstract

Aim: To compare the safety and efficacy of percutaneous computed tomography (CT)-guided core-needle biopsy (CNB) of pulmonary central masses versus ultrasound (US)-guided procedure. Materials and Methods: CT-guided and US-guided CNB of central lung lesions performed between May 2014 and January 2022 were retrospectively analysed at our hospital. Biopsies were performed using 18-G needles with a coaxial system. CT images, histopathology reports, medical records, and procedural details for all patients were reviewed to evaluate the biopsy route, complications, and diagnostic accuracy. According to the imaging equipment used, biopsies were divided into US-guided and CT-guided approaches for comparison. Results: A total of 65 patients, who had undergone 65 CNBs for central lung masses were reviewed. Ultrasound guided biopsies of central lung masses (n=22) were performed safely via a direct pathway. In this group, the sensitivity, specificity, and accuracy were 94.4%, 75% and 90.9%, respectively. In the CT guided biopsy group, there were 43 patients and we observed a sensitivity, specificity and accuracy of 86.1%, 85.7% and 86%. There were statistically significant differences in the diagnostic accuracy and lesion visibility rate among the different biopsy techniques. There was no difference in complication rates between groups. Conclusion: Percutaneous US-guided CNB using a18-G catheter with axial is more efficient technique than CT-guided procedure in the cases of central lung biopsies with atelectasis; however, as this series was small, more data is required.