Computed tomography (CT) guided lung biopsy is applied to make a diagnosis of pathological masses found on imaging and to plan future management.
The aim of this audit is to assess the performance of CT guided percutaneous lung biopsy at University Hospital Lewisham (UHL) by comparing diagnostic adequacy and complication rates against standards set by the British Thoracic Society (BTS).
This is a retrospective audit observing CT guided biopsies carried out over a twelve month period between April 2019 to March 2020.
Interventional Radiology; Biopsy; Percutaneous; Complication; Computed Tomography
Within the field of interventional radiology, Computed tomography (CT) guided percutaneous needle biopsy of the lung is a well-established method for pathologic diagnosis of pulmonary and mediastinal lesions. The use of CT-guided needle biopsy has been widely used with high accuracy and safety.
Pneumothorax and bleeding are the two most frequently encountered complications of transthoracic biopsy [1]. Fatal complications due to systemic air embolism, haemorrhage, or pericardial tamponade have been documented [2], but these are rare.
The parameters observed were compared to standards set by British Thoracic Society for the performance of CT guided lung biopsies. These standards have been approved by the Royal College of Radiologists [3].
Diagnostic adequacy and complication rates were assessed. Other data included were wait times (from the date of procedure request to the date of the biopsy), size and location of the lesion, and patient demographics.
Standard set by the BTS are as follows:
Diagnostic adequacy – 90% of samples should be sufficient for histological diagnosis.
Complication rates:
- Pneumothorax < 20%
- Pneumothorax needing drainage< 3%
- Haemoptysis < 5%
- Death < 0.15%
37 patients underwent CT guided percutaneous lung biopsy from April 2019 to March 2020.
53% (n=20) were male. The average age was 68.4 years.
Diagnostic adequacy was 97.3% (n=36). This surpassed the standard set by BTS of 90% by a significant margin.
4 patients (11%) had a negative biopsy for lung cancer.
The mean lesion size was 42.7 mm. Majority of the lesions [43.2% (n=16) were found in the left upper lobe.
The average wait time from the date of request to the date of biopsy was 10.9 days.
3 patients (8%) had a pneumothorax complication.
All 3 required chest drain insertion/aspiration. Out of these, 2 patients underwent aspiration and 1 patient required chest drain insertion.
There were no recorded haemoptysis complications or deaths.
At University Hospital Lewisham, CT guided lung biopsy diagnostic adequacy was over 90% and pneumothorax rate was less than 20% which meets the standards set by the British Thoracic Society. Pneumothorax needing drainage was slightly below par.
- Geraghty PR., Kee ST., McFarlane G., Razavi MK.,Sze DY, et al. (2003) CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. Radiology 229: 475-481. [Crossref]
- Wiener RS., Schwartz LM., Woloshin S., Welch HG (2011) Population-based risk for complications after transthoracic needle lung biopsy of a pulmonary nodule: an analysis of discharge records. Annals of Internal Medicine 155: 137-144. [Crossref]
- Percutaneous Lung Biopsy – Safety and Diagnostic Adequacy. [Crossref]
