Clinical application of CT and CT-guided percutaneous
               transthoracic needle biopsy in patients with indeterminate pulmonary nodules

Cardoso, Luciana Vargas; Souza Júnior, Arthur Soares

doi:10.1590/S1806-37132014000400005

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Jornal Brasileiro de Pneumologia

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Original Articles • J. bras. pneumol. 40 (4) • Jul-Aug 2014 • https://doi.org/10.1590/S1806-37132014000400005 copy

Clinical application of CT and CT-guided percutaneous transthoracic needle biopsy in patients with indeterminate pulmonary nodules^* * Study carried out at the São José do Rio Preto Hospital de Base, São José do Rio Preto School of Medicine, São José do Rio Preto, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

To investigate the clinical application of CT and CT-guided percutaneous transthoracic needle biopsy (CT-PTNB) in patients with indeterminate pulmonary nodules (IPNs).

METHODS:

We retrospectively studied 113 patients with PNs undergoing CT and CT-PTNB. Variables such as gender, age at diagnosis, smoking status, CT findings, and CT-PTNB techniques were analyzed. Data analysis was performed with the Student's t-test for independent samples the chi-square test, and normal approximation test for comparison of two proportions.

RESULTS:

Of the 113 patients studied, 68 (60.2%) were male and 78 (69%) were smokers. The diameter of malignant lesions ranged from 2.6 cm to 10.0 cm. Most of the IPNs (85%) were located in the peripheral region. The biopsied IPNs were found to be malignant in 88 patients (77.8%) and benign in 25 (22.2%). Adenocarcinoma was the most common malignant tumor, affecting older patients. The IPN diameter was significantly greater in patients with malignant PNs than in those with benign IPNs (p < 0.001). Having regular contour correlated significantly with an IPN being benign (p = 0.022), whereas spiculated IPNs and bosselated IPNs were more often malignant (in 50.7% and 28.7%, respectively). Homogeneous attenuation and necrosis were more common in patients with malignant lesions (51.9% and 26.9%, respectively)

CONCLUSIONS:

In our sample, CT and CT-PTNB were useful in distinguishing between malignant and benign IPNs. Advanced age and smoking were significantly associated with malignancy. Certain CT findings related to IPNs (larger diameter, spiculated borders, homogeneous attenuation, and necrosis) were associated with malignancy.

Solitary pulmonary nodule; Tomography; Image-guided biopsy

Variable	Diagnosis	n	Mean ± SD	Median (range)	p*
Age	Malignant	88	60.7 ± 12.1	63 (30-80)	0.034
Age	Benign	25	54.4 ± 12.9	60 (12-82)	0.034
Diameter	Malignant	88	5.3 ± 1.9	5.0 (2.4-10.0)	< 0.001
Diameter	Benign	25	3.7 ± 1.3	4.0 (1.8-6.5)	< 0.001

Parameter		Diagnosis		Total	p
Parameter		Malignant	Benign	Total	p
Gender	Female	39 (44.3)	06 (24.0)	45 (39.8)	0.067*
	Male	49 (55.7)	19 (76.0)	68 (60.2)	0.067*
	Total	88 (100.0)	25 (100.0)	113 (100.0)
Location	Central	15 (17.0)	02 (8.0)	17 (15.0)	0.264*
	Peripheral	73 (83.0)	23 (92.0)	96 (85.0)	0.264*
	Total	88 (100.0)	25 (100.0)	113 (100.0)
Lesion margins	Regular	12 (8.0)	16 (45.7)	28 (15.1)	0.022**
	Spiculated	76 (50.7)	09 (25.7)	85 (45.9)	0.597**
	Bosselated	43 (28.7)	06 (17.1)	49 (26.5)	0.118**
	Irregular	19 (12.6)	4 (11.4)	23 (12.4)	0.837**
	Total	150 (100.0)	35 (100.0)	185 (100.0)
Intralesional changes	Homogeneous attenuation	54 (51.9)	10 (21.3)	64 (42.4)	0.001**
	Necrosis	28 (26.9)	04 (8.5)	32 (21.2)	0.007**
	Cavitation	12 (11.5)	14 (29.8)	26 (17.2)	0.004**
	Calcification	06 (5.7)	11 (23.4)	17 (11.2)	0.003**
	Air bronchogram	04 (4.0)	08 (17.0)	12 (8.0)	0.015**
	Total	104 (100.0)	47 (100.0)	151 (100.0)

Parameter	Malignant lesion
Parameter	ADC	EPC	HL	SCC	NHL	MT	Other	Total
Gender
Female	15 (38.5)	11 (28.2)	5 (12.8)	0 (0.0)	2 (5.1)	1 (2.6)	5 (12.8)	39 (44.3)
Male	28 (57.1)	5 (10.2)	3 (6.1)	6 (12.2)	2 (4.1)	3 (6.1)	2 (4.1)	49 (55.7)
Total								88 (100)
Location
Central	2 (13.3)	0 (0.0)	8 (53.3)	2 (13.3)	1 (6.7)	0 (0.0)	2 (13.3)	15 (17.0)
Peripheral	41 (56.2)	16 (21.9)	0 (0.0)	4 (5.6)	3 (4.1)	4 (5.6)	5 (6.8)	73 (83.0)
Total								88 (100)
Lesion margins
Regular	4 (33.3)	4 (33.3)	1 (8.3)	0 (0.0)	0 (0.0)	1 (8.3)	2 (16.7)	12 (8.0)
Spiculated	39 (51.3)	12 (15.8)	7 (9.2)	6 (7.9)	4 (5.3)	3 (3.9)	5 (6.6)	76 (50.7)
Bosselated	19 (44.2)	6 (14.0)	7 (16.3)	3 (7.0)	1 (2.3)	3 (7.0)	4 (9.3)	43 (28.7)
Irregular	11 (57.9)	3 (15.8)	0 (0.0)	3 (15.8)	0 (0.0)	1 (5.3)	1 (5.3)	19 (12.6)
Total								150 (100)
Intralesional changes
Homogeneous attenuation	21 (38.9)	13 (24.1)	7 (13.0)	3 (5.6)	1 (1.9)	4 (7.4)	5 (9.3)	54 (51.9)
Necrosis	17 (60.7)	3 (10.7)	1 (3.6)	2 (7.1)	3 (10.7)	0 (0.0)	2 (7.1)	28 (26.9)
Cavitation	1 (8.3)	8 (66.7)	0 (0.0)	2 (16.7)	0 (0.0)	0 (0.0)	1 (8.3)	12 (11.5)
Calcification	1 (16.7)	1(16.7)	3 (50.0)	0 (0.0)	0( 0.0)	0 (0.0)	1 (16.7)	6 (5.7)
Air bronchogram	3 (75.0)	1 (25.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	4 (4.0)
Total								104 (100)

Sociedade Brasileira de Pneumologia e Tisiologia SCS Quadra 1, Bl. K salas 203/204, 70398-900 - Brasília - DF - Brasil, Fone/Fax: 0800 61 6218 ramal 211, (55 61)3245-1030/6218 ramal 211 - São Paulo - SP - Brazil
E-mail: jbp@sbpt.org.br

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[1] Correspondence to: Luciana Vargas Cardoso. Rua José Abdo Marão, 3838, Jardim Marin, CEP 15501-031, Votuporanga, SP, Brasil. Tel. 55 17 3422-2437. Fax: 55 17 3422-4417. E-mail: fabianonatividade@terra.com.br

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Clinical application of CT and CT-guided percutaneous transthoracic needle biopsy in patients with indeterminate pulmonary nodules* * Study carried out at the São José do Rio Preto Hospital de Base, São José do Rio Preto School of Medicine, São José do Rio Preto, Brazil.

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

Clinical application of CT and CT-guided percutaneous transthoracic needle biopsy in patients with indeterminate pulmonary nodules^* * Study carried out at the São José do Rio Preto Hospital de Base, São José do Rio Preto School of Medicine, São José do Rio Preto, Brazil.