Research Article
Volume 10 Issue 4 - 2021
Clinical Features Effecting the Diagnostic Yield of Transthoracic Needle Aspiration Biopsy in Primary Malignant Lung Tumors
Halil Yanardag1, Cuneyt Tetikkurt2*, Muammer Bilir1, Seza Tetikkurt3 and Emre Yanardag4
1Professor, Department of Internal Medicine Medicine, Cerrahpasa Medical Faculty, Istanbul Cerrahpasa University, Istanbul, Turkey
2Professor, Department of Pulmonary Medicine, Cerrahpasa Medical Faculty, Istanbul Cerrahpasa University, Istanbul, Turkey
3Professor, Department of Pathology, Demiroglu Bilim University Medical Faculty, Istanbul, Turkey
4Resident, Department of Internal Medicine, Haseki State Hospital, Istanbul, Turkey
*Corresponding Author: Cuneyt Tetikkurt, Professor, Department of Pulmonary Medicine, Cerrahpasa Medical Faculty, Istanbul Cerrahpasa University, Istanbul, Turkey.
Received: October 01, 2020; Published: March 31, 2021


The aim of this study was to determine the clinical and radiologic features that may predict the diagnostic yield of transthoracic needle aspiration biopsy in primary lung tumors. A retrospective evaluation for the final results of 284 patients was conducted to evaluate the clinical and the radiological manifestations associated with the diagnostic sensitivity and specificity of the transthoracic needle biopsy for primary pulmonary malignant tumors. Of these patients 246 had focal and 38 had diffuse lung diseases. All patients had chest x-ray and thorax CT. The patients underwent a transthoracic fine-needle aspiration biopsy under computed tomography guidance. The mean diameter of the pulmonary nodules was 24.2 ± 11.4 mm. Histopathological accuracy were obtained in 252 (88.7%) patients. Minor complications developed in %11.2 while pneumothorax occured in 6.4% of the individuals. Sensitivity and specificity of the TNA biopsy was noted to be 87.1% and 76.2%, respectively. The diagnostic accuracy of the TNA biopsy was 67.6% for primary lung tumors. Clinical and imaging manifestations were assessed to predict the diagnostic yield of the TNA biopsy for primary malignant lung tumors.

Certain radiologic features of the chest x-ray, thorax CT and PET/CT imaging were found to be extremely useful as the initial enterprises for predicting the sensitivity and specificity of the transthoracic needle aspiration biopsy for primary malignant lung tumors. Clinical manifestations revealed a low correlation relevant to the diagnostic yield of the TNAB. Imaging findings showed the highest correlation with the diagnostic accuracy of the TNA biopsy. Collaboration of the clinical and imaging results significantly increased the predictive diagnostic rendement of the TNA biopsy in regard to the sensitivity and specificity that is the hallmark to obtain adequate lung tissue compatible with the final diagnosis.

Keywords: Lung Cancer; Pulmonary Nodule; Transthoracic Needle Aspiration Biopsy; TNAB; Malignant Pulmonary Nodule


  1. Harrison BD., et al. “Percutaneous Trucut lung biopsy in the diagnosis of localised pulmonary lesions”. Thorax 7 (1984): 493-499.
  2. Lourenco R., et al. “CT-guided percutaneous transthoracic biopsy in the evaluation of undetermined pulmonary lesions”. Revista Portuguesa de Pneumologia5 (2006): 503-524.
  3. Swischuk JL., et al. “Percutaneous transthoracic needle biopsy of the lung: review of 612 lesions”. Journal of Vascular and Interventional Radiology2 (1998): 347-352.
  4. Montaudon M., et al. “Factors influencing accuracy of CT-guided percutaneous biopsies of pulmonary lesions”. European Radiology7 (2004): 1234-1240.
  5. Ohno Y., et al. “CT-guided transthoracic needle aspiration biopsy of small (< or = 20 mm) solitary pulmonary nodules”. American Journal of Roentgenology6 (2003): 1665-1669.
  6. Yoshimura N., et al. “The factors determining diagnostic accuracy in CT-guided percutaneous needle biopsy of small pulmonary nodules”. Nihon Kokyuki Gakkai Zasshi2 (2002): 101-105.
  7. Laurent F., et al. “CT-guided transthoracic needle biopsy of pulmonary nodules smaller than 20 mm: results with an automated 20-gauge coaxial cutting needle”. Clinical Radiology4 (2000): 281-287.
  8. Santambrogio L., et al. “CT-guided fine-needle aspiration cytology of solitary pulmonary nodules: a prospective, randomized study of immediate cytologic evaluation”. Chest2 (1997): 423-425.
  9. Mazza E., et al. “On-site evaluation of percutaneous CT-guided fine needle aspiration of pulmonary lesions. A study of 321 cases”. La Radiologia Medica3 (2005): 141-148.
  10. Moulton JS and Moore PT. “Coaxial percutaneous biopsy technique with automated biopsy devices: value in improving accuracy and negative predictive value”. Radiology2 (1993): 515-522.
  11. Anderson JM., et al. “CT-guided lung biopsy: factors influencing diagnostic yield and complication rate”. Clinical Radiology10 (2003): 791-797.
  12. Haramati LB. “CT-guided automated needle biopsy of the chest”. American Journal of Roentgenology1 (1995): 53-55.
  13. Birchard KR. “Transthoracic needle biopsy”. Seminars in Interventional Radiology 1 (2011): 87-97.
  14. Klein JS and Zarka MA. “Transthoracic needle biopsy”. Radiologic Clinics of North America 2 (2000): 235-266.
  15. Yanardag H., et al. “Diagnostic value of transthoracic needle biopsy in 121 cases with peripheral pulmonary mass”. The Internet Journal of Internal Medicine 4:2 (2004): 67-70.
  16. Hiraki T., et al. “CT fluoroscopy-guided biopsy of 1,000 pulmonary lesions performed with 20-gauge coaxial cutting needles: diagnostic yield and risk factors for diagnostic failure”. Chest 136 (2009): 1612-1617.
  17. Inoue D., et al. “CT fluoroscopy-guided cutting needle biopsy of focal pure ground-glass opacity lung lesions: diagnostic yield in 83 lesions”. European Journal of Radiology 81 (2012): 354-359.
  18. Hur J., et al. “Diagnostic accuracy of CT fluoroscopy-guided needle aspiration biopsy of ground-glass opacity pulmonary lesions”. American Journal of Roentgenology 192 (2009): 629-634.
  19. Zhuang YP., et al. “Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy in cavitary pulmonary lesions”. European Journal of Radiology 82 (2013): 182-186.
  20. Lee SM., et al. “C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules: clinical experience in 1108 patients”. Radiology 271 (2014): 291-300.
  21. Choo JY., et al. “Percutaneous transthoracic needle biopsy of small (≤ 1 cm) lung nodules under C-arm cone-beam CT virtual navigation guidance”. European Radiology 23 (2013): 712-719.
  22. De Filippo M., et al. “Predictive factors of diagnostic accuracy of CT-guided transthoracic fine-needle aspiration for solid noncalcified, subsolid and mixed pulmonary nodules”. La Radiologia Medica 118 (2013): 1071-1081.
  23. Inoue D., et al. “CT fluoroscopy-guided cutting needle biopsy of focal pure ground-glass opacity lung lesions: diagnostic yield in 83 lesions”. European Journal of Radiology 81 (2012): 354-359.
  24. Yamagami T., et al. “Percutaneous needle biopsy for small lung nodules beneath the rib under CT scan fluoroscopic guidance with gantry tilt”. Chest 126 (2004): 744-747.
  25. Ng YL., et al. “CT-guided percutaneous fine-needle aspiration biopsy of pulmonary nodules measuring 10 mm or less”. Clinical Radiology 63 (2008): 272-277.
  26. Zhuang YP., et al. “Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy in cavitary pulmonary lesions”. European Journal of Radiology 82 (2013): 182-186.
  27. Lee SM., et al. “C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules: clinical experience in 1108 patients”. Radiology 271 (2014): 291-300.
  28. Zhan P., et al. “Management strategy of solitary pulmonary nodules”. The Journal of Thoracic Disease 5 (2013): 824-829.
  29. Ost D., et al. “Clinical practice. The solitary pulmonary nodule”. The New England Journal of Medicine 348 (2003): 2535-2542.
  30. Li H., et al. “Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules”. AJR 167 (1996): 105-109.
  31. Haaga JR and Alfidi RJ. “Precise biopsy localization by computer tomography”. Radiology 118 (1976): 603 -607.
  32. Cohan RH., et al. “CT assistance for fluoroscopically guided transthoracic needle aspiration biopsy”. Journal of Computer Assisted Tomography 8 (1984): 1093-1098.
  33. Moore EH. “Technical aspects of needle aspiration lung biopsy: a personal perspective”. Radiology 208 (1998): 303-318.
  34. Westcott JL. “Direct percutaneous needle aspiration of localized pulmonary lesions: result in 422 patients”. Radiology 137 (1980): 31-35.
  35. Kazerooni EA., et al. “Risk of pneumothorax in CT-guided transthoracic needle aspiration biopsy of the lung”. Radiology 198 (1996): 371-375.
  36. Garcia-Rio F., et al. “Use of spirometry to predict risk of pneumothorax in CT-guided needle biopsy of the lung”. Journal of Computer Assisted Tomography 20 (1996): 20-23.
  37. Laurent F., et al. “Pneumothoraces and chest tube placement after CT-guided transthoracic lung biopsy using a coaxial technique: incidence and risk factors”. AJR 172 (1999): 1049 -1053.
  38. Ko JP., et al. “Factors influencing pneumothorax rate at lung biopsy: are dwell time and angle of pleural puncture contributing factors?” Radiology 218 (2001): 491-496.
Citation: Cuneyt Tetikkurt., et al. “Clinical Features Effecting the Diagnostic Yield of Transthoracic Needle Aspiration Biopsy in Primary Malignant Lung Tumors”. EC Pulmonology and Respiratory Medicine 10.4 (2021): 55-64.

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