Synchronous CT guided percutaneous transthoracic needle biopsy and microwave ablation for highly suspicious malignant pulmonary ground-glass nodules

Introduction: There is no consensus regarding the most appropriate management of suspected malignant pulmonary ground-glass nodules (GGNs). Objective: We aimed to explore the feasibility and safety of synchronous computed tomography guided percutaneous transthoracic needle biopsy (PTNB) and microwave ablation (MWA) for patients highly suspicious of having malignant GGNs. Methods: We retrospectively reviewed medical records between July 2020 and April 2023 from our medical center. Eligible patients synchronously underwent PTNB and MWA [either MWA immediately after PTNB (PTNB-first group), or PTNB immediately after MWA (MWA-first group)] at physician's discretion. We analyzed the rate of definitive diagnosis and technical success, the length of hospital stay, the postoperative efficacy, and periprocedural complications. Results: Of 65 patients who were enrolled, the rate of definitive diagnosis was 86.2%, which did not differ when stratified by the tumor size, the consolidation-to-tumor ratio, or the sequence of the two procedures (all P>0.05). The diagnostic rate of malignancy was 83.1%. After the median follow-up duration of 18.5 months, the local control rate was 98.2% and the rate of completed ablation was 48.2%. The rate of perioperative minor and major complications was 44.6% and 6.2%, respectively. The most common adverse events included pain, cough and mild hemorrhage. Mild hemorrhage took place significantly less frequently in MWA-first group than in PTNB-first group (16.7% vs. 45.5%, P<0.05). Conclusion: Synchronous PTNB and MWA is feasible and well tolerated for patients highly suspicious of having malignant GGNs, providing an alternative option for patients who are ineligible for surgical resection.