Computed Tomography-Guided Percutaneous Needle Biopsy of Pulmonary Nodules: Impact of Nodule Size on Diagnostic Accuracy

Purpose: This study was undertaken to compare the diagnostic accuracy and complication rate of computed tomography (CT)-guided percutaneous lung biopsies of lung nodules <= 1.5 cm versus > 1.5 cm in diameter. Patients and Methods: A total of 139 patients (age range, 18-89 years; mean, 62.5 years) underwent CT-guided percutaneous fine-needle aspiration biopsy or 20-gauge core biopsy using an automated biopsy gun. In 37 patients, the lung nodule measured <= 1.5 cm (mean, 1.1 cm), and in 102 patients, the lung nodule was > 1.5 cm (mean, 2.8 cm). Diagnostic accuracy was determined by cytopathology results. Major and minor complications were documented. Results: Overall diagnostic accuracy, pneumothorax rate, and thoracostomy tube insertion rates were 67.6%, 34.5%, and 5%, respectively. Of the 98 patients with malignancy, 77 patients (78.6%) had a definite diagnostic biopsy. Overall, nodules > 1.5 cm were statistically more likely to result in a diagnostic specimen (73.5%) than nodules <= 1.5 cm (51.4%; P = .012). Similarly, diagnostic accuracy for malignancy was higher in nodules > 1.5 cm than in those <= 1.5 cm (81.3% vs. 69.6%); however, this was not statistically significant. There was no correlation between nodule size and the incidence of complications. Conclusion: Overall, diagnostic accuracy of CT-guided percutaneous lung biopsy of lung nodules <= 1.5 cm is slightly lower than that of nodules > 1.5 cm. However, the diagnostic accuracy for malignancy is high in both groups, with a low risk of complications.