15 MM’DEN KÜÇÜK AKCİĞER NODÜLLERİNDE PERKÜTAN TRANSTORASİK BİYOPSİ SONUÇLARI

Abstract

ABSTRACT Abdurrahimli. N, Percutaneous Transthoracic Biopsy Results in Pulmonary Nodules Smaller than 15 mm, Hacettepe University, Faculty of Medicine, Department of Radiology, Thesis In Radiology, Ankara, 2023. Objective: To evaluate the safety and efficacy of percutaneous transthoracic lung biopsy (PTB) in nodules smaller than 15 mm. Introduction: Computed tomography (CT) guided lung biopsy plays a significant role in the diagnosis of lung lesions. Pneumothorax, hemorrhage, and rarely air embolism may occur following the procedure. Factors such as small nodule size, central localization, proximity to major bronchi or vascular structures, and underlying parenchymal diseases may increase the risk of complications. There is limited literature regarding the efficacy of PTB in small-sized lung lesions. Materials and Methods: Adult patients who underwent CT guided PTB at Hacettepe University Nonvascular Interventional Radiology unit between January 2005 and June 2020 were included in the study. Demographic data, underlying lung diseases, nodule size, localization, needle distance from the lesion to the pleura, postprocedural complications, and histopathological diagnoses were retrospectively reviewed. Factors potentially related to complications were investigated individually. Results: The study included a total of 97 patients (56 % male) with a mean age of 63±9,9 years. The mean long axis of biopsied nodules was 12±2,3 mm. Nodules were 1-9 mm in size in 15% (n=15) of cases, 10-12 mm in 41% (n=40), and 13-15 mm in 44% (n=42). Diagnostic accuracy rate was 95%. In 5 of the patients (5%) specific diagnosis could not be achieved. Inadequate sampling rate was higher in patients with a needle distance from the lesion to the pleura of less than 3 cm compared to other groups (3-4.9 cm and 5 cm or more) (p=0,026). Most complications (84%) were clinically insignificant hemorrhages (51 patients) and pneumothoraxes that did not require drainage (14 patients). Two patients required drainage catheter placement following pneumothorax. Grade 2 or higher hemorrhage was observed in 19 patients (20%). None of the patients with hemorrhage required further intervention. Two patients with hemoptysis showed spontaneous resolution on the same day with the procedure. There were no cases of parenchymal hemorrhage or hemoptysis that prolonged the hospital stay. Sixty-one patients (63%) were treated as an outpatient basis. Thirty six of the patients (37%) were managed as an inpatient. Among these 36 patients, two required delayed discharge on the 3rd and 5th days due to pneumothorax requiring drainage. The remaining 34 patients were discharged the day after biopsy. The frequency of parenchymal hemorrhage was significantly higher in the setting of increased needle distance from the lesion to the pleura (p=0,008). Similarly, the risk of hemorrhage was higher in nodules adjacent to nearest pulmonary fissure (<1 cm) (p=0,019). Conclusion: In this study, it has been demonstrated that PTB is an effective and safe method for lung nodules smaller than 15 mm. As a conclusion of our study, we recommend choosing the parenchymal access which enables higher manipulation capability of the needle to ensure accurate histopathological diagnosis. The shortest distance to nodule may result in an unsuccessful procedure. Keywords: Lung, nodule, CT, percutaneous transthoracic biopsy.