Estudo do valor diagnóstico das biópsias percutâneas guiadas por tomografia computadorizada nas doenças infecciosas e neoplásicas do tórax

Abstract

The diagnostic value of CT-guided percutaneous core needle biopsy (PCNB) of thoracic lesions, irrespective of their mediastinal or pulmonary origin, is unclear in the literature. Moreover, little is known about which variables (if any) might be most consistently associated with a final diagnosis of malignancy and/or occurrence of complications. OBJECTIVE: To assess the impact of factors related to the patient, lesion and procedure on the risks of complications and final diagnosis of malignancy in CT-guided PCNB of mediastinal and lung lesions. CASUISTICS AND METHODS: A wide Brazilian cohort from a single center of 235 consecutive patients (66.8% men; 58.5 ± 18.0 years) were studied. A range of thoracic benign and malignant lesions, who underwent PCNB performed by a single experienced radiologist. Diagnostic accuracy analyses of PCNB for malignancy were performed, as well as estimates of relative risk and logistic regression models in order to assess possible associations between such factors and malignancy/complications. RESULTS: A total of 155 lesions (65.9%) were diagnosed as malignant. Overall accuracy was 91.1%, with sensitivity of 87.1%, specificity of 98.8%, positive predictive value of 99.3%, and negative predictive value of 79.8%. Pneumothorax (49; 20.8%) and hemorrhage (37; 15.7%) were the most common complications. Emphysema, older age, intrapulmonary location, higher depth, smaller size, presence of cavitations and irregular contours of the lesions, and smaller needle-pleural angles were the most consistent factors related to the occurrence of complications. Emphysema, smoking, solid and deeper lesions were also significantly associated with malignancy. CONCLUSION: PCNB is a safe procedure with high diagnostic accuracy for the clinical work up of patients with indeterminate thoracic lesions.