Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 11  |  Issue : 8  |  Page : 231-233

Percutaneous computed tomography-guided lung biopsy of solitary nodular ground-glass opacity


1 Department of Radiology, Huzhou Central Hospital, Huzhou 313000, China
2 Department of Interventional Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, China
3 Zhejiang Key Laboratory of Diagnosis and Treatment Technology Research on Chest Tumor (Lung, Esophagus), Zhejiang Cancer Hospital, Hangzhou 310022, China
4 Department of Respiration, Quzhou People's Hospital, Quzhou 324000, Zhejiang, China

Date of Web Publication26-Nov-2015

Correspondence Address:
Han Zhi-Qiang
Department of Respiration, Quzhou People's Hospital, Quzhou 324000, Zhejiang
China
Jiang Li-Ming
Department of Interventional Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang
China
Mao Wei-Min
Zhejiang Key Laboratory of Diagnosis and Treatment Technology Research on Chest Tumor (Lung, Esophagus), Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.162117

Rights and Permissions
 > Abstract 

Objective: To evaluate the diagnostic performance and safety of percutaneous lung biopsy under computed tomography (CT)-fluoroscopic guidance for ground-glass opacity (GGO) lesions.
Materials and Methods: Thirty-eight patients received core biopsy utilizing an automated cutting needle and were evaluated histologically.
Results: Five patients had a bronchioloalveolar carcinoma, 3 patients had adenocarcinomas, 18 patients had pulmonary alveoli epithelial dysplasia, 1 patient had a large number of lymphocytes, and 11 patients had a small amount of fibrous connective tissue. Twenty-three lesions (23/38, 60.5%) were located in the upper lobes while 15 lesions (15/38, 39.5%) were located in the lower lobes. Twenty-five lesions (25/38, 65.8%) were located in the right lung while 13 lesions (13/38, 34.2%) were located in the left lung. Three patients had pneumothorax, appeared on CT images performed immediately after the biopsy. Four patients had mild parenchymal hemorrhage along the needle tract or within the lesion. No patient required additional therapy such as a blood transfusion, endotracheal intubation, or chest tube placement after the biopsy. None of the patients had serious complications.
Conclusion: Percutaneous CT-guided aspiration can be useful and safe diagnostic procedures for evaluating GGO nodules and a guidance to make a clinical decision for further patient management.

Keywords: Computed tomography, ground-glass opacity, needle biopsy


How to cite this article:
Yi-Feng Z, Li-Ming J, Wei-Min M, Zhi-Qiang H. Percutaneous computed tomography-guided lung biopsy of solitary nodular ground-glass opacity. J Can Res Ther 2015;11, Suppl S4:231-3

How to cite this URL:
Yi-Feng Z, Li-Ming J, Wei-Min M, Zhi-Qiang H. Percutaneous computed tomography-guided lung biopsy of solitary nodular ground-glass opacity. J Can Res Ther [serial online] 2015 [cited 2019 Sep 16];11:231-3. Available from: http://www.cancerjournal.net/text.asp?2015/11/8/231/162117

Z h e n g Y i - F e n g and Jiang Li-Ming contributed equally to this work.



 > Introduction Top


Ground-glass opacity (GGO) nodules are often the first sign of pulmonary malignancies. The detection and differentiation of GGO nodules are important for the early diagnosis and treatment of such tumors. GGO refers to an area of increased lung attenuation without obscuration of underlying vessels on thin-section computed tomography (CT). Although it has been reported that the morphologic classification is helpful to differentiate malignant GGO lesions from benign conditions, it is generally considered very difficult based on CT findings alone.[1],[2] The Periodic follow-up to assess interval changes or surgical resection is necessary for the management of a persistent GGO lesion. However, limited surgical excision may be difficult in patients with high comorbidities and poor lung function. Percutaneous biopsy of pulmonary nodules has been established as a safe diagnostic procedure, with high diagnostic performance and a diagnostic accuracy as high as 90%.[3],[4],[5],[6],[7] However, the diagnostic performance of percutaneous biopsy of solitary nodular GGO nodules, which are usually detected on CT, has not been fully investigated. Therefore, we investigated the diagnostic outcomes of percutaneous CT-guided aspiration and core biopsy of GGO nodules.


 > Materials and Methods Top


Thirty-eight patients (15 females and 23 males, mean age 59.5 years and age range 34–78 years) with persistent pulmonary GGO lesions smaller than or equal to 2 cm who received percutaneous CT-guided lung biopsies between January 2013 and December 2014 at Zhejiang Cancer Hospital were enrolled in this study. The final histologic results of the patients were analyzed and compared with the CT images. This study was approved by the hospital's Institutional Review Board, and informed consent was obtained from all patients.

All patients had undergone diagnostic CT of the chest with contiguous axial tomographic sections before the biopsy. An 18-gauge Monopty biopsy needle (Bard, Covington, GA, USA), which is a fully automated cutting needle was used. Limited 3 mm and/or 1 mm thin-section images were used routinely to plan the needle path. The guiding needle was aimed at the less vascular area of the GGO lesion, and a single pleural penetration was performed. Patients who could not co-operate with breath-holding underwent the procedure during usual respiration. After confirming the needle tip had reached the lesion, a specimen was obtained, and the needle was withdrawn. When the operator was uncertain as to whether the needle tip had reached the lesion or if the specimen was insufficient, rebiopsy was performed. The procedure was stopped immediately if significant bleeding, hemoptysis, severe chest pain, or a change in vital signs occurred. Limited CT images were performed a few minutes after removal of the biopsy needle.

Specimens obtained by tissue-core biopsy were evaluated histologically. All histological evaluations were performed by experienced chest pathologists who were required not only to classify obtained specimens as positive or negative for malignancy but also to identify specific cell types.


 > Results Top


Twenty-three lesions (23/38, 60.5%) were located in the upper lobes while 15 lesions (15/38, 39.5%) were located in the lower lobes. Twenty-five lesions (25/38, 65.8%) were located in the right lung while 13 lesions (13/38, 34.2%) were located in the left lung. Three patients had pneumothorax, appeared on CT images performed immediately after the biopsy. Four patients had mild parenchymal hemorrhage along the needle tract or within the lesion. No patient required additional therapy such as a blood transfusion, endotracheal intubation, or chest tube placement after the biopsy. None of the patients had serious complications.

The final pathology of the GGO lesions showed that 5 patients had bronchioloalveolar carcinoma (BAC), 3 patients had adenocarcinomas, 18 patients had pulmonary alveoli epithelial dysplasia, 1 patient had a large number of lymphocytes, and 11 patients had a small amount of fibrous connective tissue [Figure 1].
Figure 1: (a) A 74-year-old woman was noted to have a pure ground-glass opacity lesion in the right up lobe during computed tomography scan. (b) Percutaneous computed tomography-guided trephine needle biposy was performed with a coaxial needle introduced to the edge of the lesion. (c and d) Histopathologic specimen from the core biopsy (H and E, ×400) showed pulmonary alveoli epithelial dysplasia, confirmed bronchioloalveolar carcinoma

Click here to view



 > Discussion Top


The management for small lung nodules according to the guidelines is a follow-up for a period as long as 24 months.[8],[9] However, ome malignant tumors will progress from resectable to unresectable disease.[10] Lobectomy for GGO lesions and lymph node dissection can be performed after confirming the histopathologic results from intraoperative frozen sections if adenocarcinoma is diagnosed.[11],[12] Unfortunately, interpretation of frozen sections of small GGO lesions may be difficult and remains challenging.[13],[14],[15] Clarification of the specific cell type should be necessary for a lesion in the lung. Core biopsy or a combination of core and aspiration biopsy is required for higher diagnostic accuracy and more pathologic information. Percutaneous image-guided lung biopsy has found widespread acceptance as a principal method of diagnosing lung nodules. It is known that percutaneous CT-guided core biopsy is an accurate diagnostic technique for lung lesions.[16] The results of our study could be used to make clinical decisions about GGO nodules.

GGO can be due to variable etiologies, such as well-differentiated adenocarcinoma, nodular fibrosis, BAC, atypical adenomatous hyperplasia, focal scar, granuloma, and lymphoproliferative disease.[1],[17] It has been reported that 75% of persistent GGO nodules are attributable to BAC or adenocarcinoma with a predominant BAC component.[2] It has also been shown that the greater the portion of GGO, the lower the frequency of nodal involvement and better prognosis in lung adenocarcinoma.[18],[19],[20]

Our results showed that the majority of persistent GGO lesions were attributable to pulmonary alveoli epithelial dysplasia (47.4%), fibrous connective tissue (28.9%), and lung carcinoma (21%). There was a controversy for the treatment of pulmonary alveoli epithelial dysplasia which was regarded as precancerous lesion needed early surgical resection.[2] We suggest that for these patients, close attention should be paid and follow-up the morphological changes. If the growth of the lesions or substantive components increases, surgical resection is recommended. It is unnecessary to have operation for the pathology of fibrous connective tissue. In this study, there was no serious complication through the procedure. 3 (7.9%) patients had pneumothorax and 4 (10.5%) patients had mild parenchymal hemorrhage along the needle tract or within the lesion. No patient required additional therapy such as a blood transfusion, endotracheal intubation, or chest tube placement after the biopsy.


 > Conclusion Top


We found that percutaneous CT-guided aspiration could be useful and safe diagnostic procedures for evaluating GGO nodules and a guidance to make a clinical decision for further patient management. However, the patient number was small which may require further studies in the future.

Acknowledgments

The present study was supported by grants from the National Natural Science Foundation of China (grant no. 81303274; and grant no. 81202947).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

1.
Li F, Sone S, Abe H, Macmahon H, Doi K. Malignant versus benign nodules at CT screening for lung cancer: Comparison of thin-section CT findings. Radiology 2004;233:793-8.  Back to cited text no. 1
    
2.
Kim HY, Shim YM, Lee KS, Han J, Yi CA, Kim YK. Persistent pulmonary nodular ground-glass opacity at thin-section CT: Histopathologic comparisons. Radiology 2007;245:267-75.  Back to cited text no. 2
    
3.
Lee SM, Park CM, Lee KH, Bahn YE, Kim JI, Goo JM. C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules: Clinical experience in 1108 patients. Radiology 2014;271:291-300.  Back to cited text no. 3
    
4.
De Filippo M, Saba L, Concari G, Nizzoli R, Ferrari L, Tiseo M, et al. Predictive factors of diagnostic accuracy of CT-guided transthoracic fine-needle aspiration for solid noncalcified, subsolid and mixed pulmonary nodules. Radiol Med 2013;118:1071-81.  Back to cited text no. 4
    
5.
Li Y, Du Y, Yang HF, Yu JH, Xu XX. CT-guided percutaneous core needle biopsy for small (≤20 mm) pulmonary lesions. Clin Radiol 2013;68:e43-8.  Back to cited text no. 5
    
6.
Mukherjee S, Bandyopadhyay G, Bhattacharya A, Ghosh R, Barui G, Karmakar R. Computed tomography-guided fine needle aspiration cytology of solitary pulmonary nodules suspected to be bronchogenic carcinoma: Experience of a general hospital. J Cytol 2010;27:8-11.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.
Kothary N, Bartos JA, Hwang GL, Dua R, Kuo WT, Hofmann LV. Computed tomography-guided percutaneous needle biopsy of indeterminate pulmonary pathology: Efficacy of obtaining a diagnostic sample in immunocompetent and immunocompromised patients. Clin Lung Cancer 2010;11:251-6.  Back to cited text no. 7
    
8.
Lu CH, Hsiao CH, Chang YC, Lee JM, Shih JY, Wu LA, et al. Percutaneous computed tomography-guided coaxial core biopsy for small pulmonary lesions with ground-glass attenuation. J Thorac Oncol 2012;7:143-50.  Back to cited text no. 8
    
9.
Lee SW, Leem CS, Kim TJ, Lee KW, Chung JH, Jheon S, et al. The long-term course of ground-glass opacities detected on thin-section computed tomography. Respir Med 2013;107:904-10.  Back to cited text no. 9
    
10.
Ichinose J, Kohno T, Fujimori S, Harano T, Suzuki S, Fujii T. Invasiveness and malignant potential of pulmonary lesions presenting as pure ground-glass opacities. Ann Thorac Cardiovasc Surg 2014;20:347-52.  Back to cited text no. 10
    
11.
Ohtsuka T, Watanabe K, Kaji M, Naruke T, Suemasu K. A clinicopathological study of resected pulmonary nodules with focal pure ground-glass opacity. Eur J Cardiothorac Surg 2006;30:160-3.  Back to cited text no. 11
    
12.
Mun M, Kohno T. Efficacy of thoracoscopic resection for multifocal bronchioloalveolar carcinoma showing pure ground-glass opacities of 20 mm or less in diameter. J Thorac Cardiovasc Surg 2007;134:877-82.  Back to cited text no. 12
    
13.
Marchevsky AM, Changsri C, Gupta I, Fuller C, Houck W, McKenna RJ Jr. Frozen section diagnoses of small pulmonary nodules: Accuracy and clinical implications. Ann Thorac Surg 2004;78:1755-9.  Back to cited text no. 13
    
14.
Shimada Y, Saji H, Otani K, Maehara S, Maeda J, Yoshida K, et al. Survival of a surgical series of lung cancer patients with synchronous multiple ground-glass opacities, and the management of their residual lesions. Lung Cancer 2015;88:174-80.  Back to cited text no. 14
    
15.
Cho JH, Choi YS, Kim J, Kim HK, Zo JI, Shim YM. Long-term outcomes of wedge resection for pulmonary ground-glass opacity nodules. Ann Thorac Surg 2015;99:218-22.  Back to cited text no. 15
    
16.
Chang YC, Yu CJ, Lee WJ, Kuo SH, Hsiao CH, Jan IS, et al. Imprint cytology improves accuracy of computed tomography-guided percutaneous transthoracic needle biopsy. Eur Respir J 2008;31:54-61.  Back to cited text no. 16
    
17.
Yoshida J, Nagai K, Yokose T, Nishimura M, Kakinuma R, Ohmatsu H, et al. Limited resection trial for pulmonary ground-glass opacity nodules: Fifty-case experience. J Thorac Cardiovasc Surg 2005;129:991-6.  Back to cited text no. 17
    
18.
Matsuguma H, Nakahara R, Anraku M, Kondo T, Tsuura Y, Kamiyama Y, et al. Objective definition and measurement method of ground-glass opacity for planning limited resection in patients with clinical stage IA adenocarcinoma of the lung. Eur J Cardiothorac Surg 2004;25:1102-6.  Back to cited text no. 18
    
19.
Ikeda N, Maeda J, Yashima K, Tsuboi M, Kato H, Akada S, et al. A clinicopathological study of resected adenocarcinoma 2 cm or less in diameter. Ann Thorac Surg 2004;78:1011-6.  Back to cited text no. 19
    
20.
Miao XH, Yao YW, Yuan DM, Lv YL, Zhan P, Lv TF, et al. Prognostic value of the ratio of ground glass opacity on computed tomography in small lung adenocarcinoma: A meta-analysis. J Thorac Dis 2012;4:265-71.  Back to cited text no. 20
    


    Figures

  [Figure 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  >Abstract>Introduction>Materials and Me...>Results>Discussion>Conclusion>Article Figures
  In this article
>References

 Article Access Statistics
    Viewed2777    
    Printed83    
    Emailed0    
    PDF Downloaded278    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]