| Abstract [eng] |
Justification of the work CT-guided transthoracic lung biopsy is a widely used minimally invasive procedure characterized by high diagnostic accuracy in the evaluation of pulmonary lesions. This procedure plays a crucial role in the diagnostic workup of lung cancer, as it allows for the acquisition of sufficient tissue for histological and molecular analysis. This is essential for selecting appropriate and individualized treatment strategies. Despite its high diagnostic performance, the procedure is associated with a risk of complications, and its success depends on several factors, including lesion size, location, and biopsy technique. Data on the effectiveness of CT-guided transthoracic lung biopsy in real-world clinical practice in Lithuania remain limited; therefore, this study contributes to the existing body of literature. Aim and objectives of the study The aim of the study was to evaluate the diagnostic yield and safety of CT-guided transthoracic lung lesion biopsy and to identify factors associated with diagnostic success. Objectives: 1. To evaluate diagnostic performance measures (sensitivity, specificity, and diagnostic yield); 2. To analyze factors influencing diagnostic yield; 3. To assess the frequency and nature of procedure-related complications and to identify factors associated with their occurrence. Research methods A retrospective analysis included 356 patients who underwent CT-guided transthoracic lung biopsy between 2021 and 2023. Patient demographic data (age, sex), lesion characteristics (size, location—right or left lung, central or peripheral, radiological type), number of biopsy cores obtained, histological results, and procedure-related complications were evaluated. Data analysis was performed using IBM SPSS Statistics software, version 20.0 (IBM Corp., Armonk, NY, USA). The following statistical methods were applied: χ² (chi-square) test, one-way analysis of variance (ANOVA), and logistic regression. A literature search was also conducted using the PubMed database. Results Of the 356 biopsies, 326 (91.6%) were found to be diagnostic, and 30 (8.4%) were non-diagnostic. The diagnostic yield was significantly influenced by lesion size and the number of biopsy cores, with lesions ≤ 2 cm associated with a higher diagnostic failure rate (p = 0.034). A significant interaction was also observed between lesion size and core number (p < 0.001). The overall complication rate was 11.5%, with pneumothorax being the most frequent event (7.0%). CIRSE grade 2 and grade 3 complications occurred in 4.8% and 3.1% of cases, respectively. Solid lesion morphology was identified as an independent predictor of complications (OR = 1.67, p = 0.022). Conclusions CT-guided transthoracic lung biopsy has a high diagnostic success rate (91.6%), acceptable sensitivity (97.9%) and specificity (85.2%). Malignant lesions had a significantly higher diagnostic success rate than benign lesions, emphasizing the technique’s value in lung cancer diagnosis and staging. Lesions ≥ 2 cm were associated with higher diagnostic yield, particularly in malignant cases. Obtaining 3–5 biopsy cores was an independent predictor of lower diagnostic success. In this cohort, diagnostic yield was highest when two cores were obtained; however, the association between a higher number of cores and lower diagnostic success likely reflects increased procedural complexity rather than a direct causal relationship. CT-guided transthoracic lung biopsy demonstrated an acceptable safety profile, with mostly CIRSE grade 1 complications. Higher-grade complications were less common, and severe complications were rare. Solid lesion morphology was the only independent predictor. However, given inconsistent findings reported in the literature, the influence of lesion morphology on overall procedural safety appears variable. |
