Outcomes of CT-Guided Percutaneous Transthoracic Needle Biopsy of Cavitary Pulmonary Nodules

Rationale and Objectives: Current literature on the outcomes of CT-guided percutaneous transthoracic needle biopsy (PTNB) of cavitary pulmonary nodules is limited by small sample sizes. The purpose of our study was to evaluate the diagnostic performance and to identify factors contributing to complications associated with PTNB of cavitary pulmonary nodules. Materials and Methods: In this single-center, retrospective cohort study, we examined patients who underwent PTNB of cavitary lesions between July 2014 and July 2021. Through medical chart review and image analysis by a blinded radiologist, we collected data on patient demographics, lesion characteristics, perilesional features, procedural factors, postoperative complications, and pathological results. We assessed the diagnostic performance of PTNB with receiver operating characteristic analysis for malignant neoplasm. Multivariable logistic regression models were constructed and adjusted for clinical information and imaging characteristics to examine the outcomes of hemorrhage and pneumothorax. Results: A total of 202 patients were included (52% female; mean age 67.3 years; standard deviation 11.2 years). Sixty-seven percent of patients demonstrated malignant neoplasm on pathology, with sensitivity and specificity rates of 93% and 100%, respectively, for PTNB. Hemorrhage, pneumothorax, and chest tube placement occurred in 34%, 31%, and 8% of biopsies, respectively. Small lesion size (p < 0.0001), large gauge needle (p = 0.02), and increased distance from the pleura (p < 0.0001) were associated with increased risk of hemorrhage. The odds of pneumothorax were higher with advanced age (p = 0.0008) and increased distance from the pleura (p = 0.04). Only increased distance from the pleura was associated with an increased likelihood of chest tube placement (p = 0.01). Conclusion: The diagnostic performance and safety of PTNB for cavitary nodules demonstrated excellent operating characteristics and a favorable safety profile, similar to published results for biopsies of solid pulmonary nodules.