Advertisement

Percutaneous computed tomography guided biopsy of sub-solid pulmonary nodules: differentiating solid from ground glass components at the time of biopsy

      Highlights

      • Solid portions of part solid nodules are visible during biopsy in 83% of nodules.
      • Larger lesion size is associated with visibility of solid components during biopsy.
      • Percutaneous biopsy pathology and surgical pathology results were compared.
      • A small minority showed differences in the invasive component between the 2 biopsies.

      Abstract

      Introduction

      This study assessed (i) the ability to identify the solid components of part-solid nodules (PSN) during computed tomography (CT) guided lung biopsy (CTGLB), (ii) the ability of CTGLB to assess the invasive nature of a nodule on pathology.

      Materials and methods

      Sixty-nine nodules were studied in 68 patients who underwent CTGLB between 1/1/2014 and 10/31/2015. Diagnostic CT images and CTGLB images were reviewed. On diagnostic CT images, nodules were classified as ground glass nodules (GGN) or PSNs. Nodule size, location, and percentage of solid component were recorded. At the time of biopsy, the ability to visualize the solid component of a PSN, depth of lesion from skin, and ability to identify the needle within the solid component were recorded.

      Results

      There were 42 (61%) part-solid nodules and 27 (39%) GGNs. During biopsy, it was possible to differentiate the solid from the ground glass components in 35 (83%) PSNs. Fifty-nine (86%) nodules were neoplastic based on biopsy pathology (all non-small cell lung carcinoma). Thirty-nine (66%) were resected. In all cases biopsy pathology and surgical pathology agreed regarding the presence of lung carcinoma. In 6 (15%) cases biopsy pathology demonstrated purely lepidic growth but had some non-lepidic growth on surgical pathology, including 2 cases with acinar growth as a dominant pattern.

      Conclusion

      In most patients, the solid and ground glass components of a PSN were distinguishable when performing a CTGLB. In a minority of patients, discrepancy was noted between biopsy pathology and surgical pathology regarding the invasive nature of a nodule.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Henschke C.I.
        • Yip R.
        • Smith J.P.
        • Wolf A.S.
        • Flores R.M.
        • Liang M.
        CT screening for lung cancer: part-solid nodules in baseline and annual repeat rounds.
        AJR Am J Roentgenol. 2016; 207: 1176-1184https://doi.org/10.2214/ajr.16.16043
        • Henschke C.I.
        • Yankelevitz D.F.
        • Mirtcheva R.
        • McGuinness G.
        • McCauley D.
        • Miettinen O.S.
        CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules.
        AJR Am J Roentgenol. 2002; 178: 1053-1057https://doi.org/10.2214/ajr.178.5.1781053
        • Austin J.H.
        • Muller N.L.
        • Friedman P.J.
        • Hansell D.M.
        • Naidich D.P.
        • Remy-Jardin M.
        • et al.
        Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society.
        Radiology. 1996; 200: 327-331https://doi.org/10.1148/radiology.200.2.8685321
        • Travis W.D.
        • Brambilla E.
        • Noguchi M.
        • Nicholson A.G.
        • Geisinger K.R.
        • Yatabe Y.
        • et al.
        International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. Journal of thoracic oncology: official publication of the International Association for the Study of.
        Lung Cancer. 2011; 6: 244-285https://doi.org/10.1097/JTO.0b013e318206a221
        • Detterbeck F.C.
        • Marom E.M.
        • Arenberg D.A.
        • Franklin W.A.
        • Nicholson A.G.
        • Travis W.D.
        • et al.
        The IASLC lung cancer staging project: background data and proposals for the application of TNM staging rules to lung Cancer presenting as multiple nodules with ground glass or lepidic features or a pneumonic type of involvement in the forthcoming eighth edition of the TNM classification.
        J Thorac Oncol. 2016; 11: 666-680https://doi.org/10.1016/j.jtho.2015.12.113
        • Asamura H.
        • Hishida T.
        • Suzuki K.
        • Koike T.
        • Nakamura K.
        • Kusumoto M.
        • et al.
        Radiographically determined noninvasive adenocarcinoma of the lung: survival outcomes of Japan clinical oncology group 0201.
        J Thorac Cardiovasc Surg. 2013; 146: 24-30https://doi.org/10.1016/j.jtcvs.2012.12.047
        • Nakamura S.
        • Fukui T.
        • Kawaguchi K.
        • Fukumoto K.
        • Hirakawa A.
        • Yokoi K.
        Does ground glass opacity-dominant feature have a prognostic significance even in clinical T2aN0M0 lung adenocarcinoma?.
        Lung cancer (Amsterdam, Netherlands). 2015; 89: 38-42https://doi.org/10.1016/j.lungcan.2015.04.011
      1. National Comprehensive Cancer Network NCCN clinical practice guidelines in oncology (NCCN Guidelines) with NCCN evidence blocks.
        • American College of Radiology
        Lung CT screening reporting and data system (lung-RADS).
        American College of Radiology
        https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Lung-Rads
        Date: 2014
        • Naidich D.P.
        • Bankier A.A.
        • MacMahon H.
        • Schaefer-Prokop C.M.
        • Pistolesi M.
        • Goo J.M.
        • et al.
        Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society.
        Radiology. 2013; 266: 304-317https://doi.org/10.1148/radiol.12120628
        • Hur J.
        • Lee H.J.
        • Nam J.E.
        • Kim Y.J.
        • Kim T.H.
        • Choe K.O.
        • et al.
        Diagnostic accuracy of CT fluoroscopy-guided needle aspiration biopsy of ground-glass opacity pulmonary lesions.
        AJR Am J Roentgenol. 2009; 192: 629-634https://doi.org/10.2214/ajr.08.1366
        • Kim T.J.
        • Lee J.H.
        • Lee C.T.
        • Jheon S.H.
        • Sung S.W.
        • Chung J.H.
        • et al.
        Diagnostic accuracy of CT-guided core biopsy of ground-glass opacity pulmonary lesions.
        AJR Am J Roentgenol. 2008; 190: 234-239https://doi.org/10.2214/ajr.07.2441
        • Hasegawa M.
        • Sone S.
        • Takashima S.
        • Li F.
        • Yang Z.G.
        • Maruyama Y.
        • et al.
        Growth rate of small lung cancers detected on mass CT screening.
        Br J Radiol. 2000; 73: 1252-1259https://doi.org/10.1259/bjr.73.876.11205667
        • Woo T.
        • Okudela K.
        • Mitsui H.
        • Tajiri M.
        • Yamamoto T.
        • Rino Y.
        • et al.
        Prognostic value of the IASLC/ATS/ERS classification of lung adenocarcinoma in stage I disease of Japanese cases.
        Pathol Int. 2012 Dec; 62: 785-791
        • Yang J.S.
        • Liu Y.M.
        • Mao Y.M.
        • Yuan J.H.
        • Yu W.Q.
        • Cheng R.D.
        • et al.
        Meta-analysis of CT-guided transthoracic needle biopsy for the evaluation of the ground-glass opacity pulmonary lesions.
        Br J Radiol. 2014; 8720140276https://doi.org/10.1259/bjr.20140276
        • Inoue D.
        • Gobara H.
        • Hiraki T.
        • Mimura H.
        • Kato K.
        • Shibamoto K.
        • et al.
        CT fluoroscopy-guided cutting needle biopsy of focal pure ground-glass opacity lung lesions: diagnostic yield in 83 lesions.
        Eur J Radiol. 2012; 81: 354-359https://doi.org/10.1016/j.ejrad.2010.11.025
        • Lu C.H.
        • Hsiao C.H.
        • Chang Y.C.
        • Lee J.M.
        • Shih J.Y.
        • Wu L.A.
        • et al.
        Percutaneous computed tomography-guided coaxial core biopsy for small pulmonary lesions with ground-glass attenuation. Journal of thoracic oncology: official publication of the International Association for the Study of.
        Lung Cancer. 2012; 7: 143-150https://doi.org/10.1097/JTO.0b013e318233d7dd
        • Yamauchi Y.
        • Izumi Y.
        • Nakatsuka S.
        • Inoue M.
        • Hayashi Y.
        • Mukai M.
        • et al.
        Diagnostic performance of percutaneous core needle lung biopsy under multi-CT fluoroscopic guidance for ground-glass opacity pulmonary lesions.
        Eur J Radiol. 2011; 79: e85-e89https://doi.org/10.1016/j.ejrad.2011.03.088
        • Yamagami T.
        • Yoshimatsu R.
        • Miura H.
        • Yamada K.
        • Takahata A.
        • Matsumoto T.
        • et al.
        Diagnostic performance of percutaneous lung biopsy using automated biopsy needles under CT-fluoroscopic guidance for ground-glass opacity lesions.
        Br J Radiol. 2013; 8620120447https://doi.org/10.1259/bjr.20120447