CT-guided biopsy of pulmonary ground-glass nodules: core-needle biopsy versus fine-needle aspiration

Le résumé fourni par la source

To compare the diagnostic performance and complication profiles of CT-guided core-needle biopsy (CNB) and fine-needle aspiration (FNA) for pulmonary ground-glass nodules (GGNs). Consecutive patients who underwent CT-guided percutaneous biopsy of pulmonary GGNs between January 2021 and August 2022 were screened. Of 657 patients assessed, 538 were included (CNB, n = 448; FNA, n = 90). Six FNA results classified as atypical cells were considered indeterminate and excluded from binary diagnostic-performance analyses, leaving 532 classifiable cases. Final diagnoses were established by surgical pathology or imaging follow-up of at least 12 months. Diagnostic performance was compared without adjustment, whereas complication outcomes were assessed using multivariable logistic regression and inverse probability of treatment weighting (IPTW). Among the 532 classifiable biopsies, the overall accuracy, sensitivity, and specificity were 93.2%, 91.4%, and 100.0%, respectively, based on the available composite reference standard. CNB showed higher unadjusted accuracy than FNA (94.6% vs. 85.7%, P = 0.007) and higher sensitivity (93.2% vs. 82.4%, P = 0.008). In the full cohort of 538 procedures, multivariable analysis showed that CNB was associated with higher odds of intrapulmonary hemorrhage (adjusted odds ratio [aOR]: 2.91; P < 0.001) and hemoptysis (aOR: 3.07; P < 0.001), whereas no statistically significant association was observed for pneumothorax. CT-guided percutaneous biopsy yielded determinate diagnostic results for most pulmonary GGNs under the available composite reference standard. In unadjusted comparisons, CNB showed higher diagnostic accuracy and sensitivity than FNA but was associated with greater risks of hemorrhagic complications. Given the lack of adjustment for baseline differences in diagnostic-performance analyses, the apparent diagnostic advantage of CNB should be interpreted cautiously. Biopsy technique should be individualized according to lesion characteristics and patient-specific risks.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.