Percutaneous Computed Tomography-Guided Coaxial Core Biopsy for Small Pulmonary Lesions with Ground-Glass Attenuation

Introduction: The aim of this study was to investigate the diagnostic value of percutaneous computed tomography (CT)-guided coaxial transthoracic needle biopsy (TNB) for small pulmonary lesions (<= 3 cm) with persistent ground-glass opacity (GGO). Methods: From January 2004 to February 2010, consecutive patients with persistent small GGO lesions (<= 3 cm) who underwent CT-guided TNB were analyzed. The pathologic results of CT-guided TNB were compared with final diagnoses, and the GGO percentage on CT was correlated with the stromal invasion in surgical pathology. Results: We performed CT-guided TNB on 1612 patients during the study period. Among them, 55 patients had persistent small GGO lesions (size range 0.5-3.0 cm; 1.72 +/- 0.73 cm), 47 were diagnosed with lung adenocarcinomas, and 8 with benign nonspecific lesions. Minor procedure-related complications occurred in 26 patients (47.3%) with small pneumothorax and 11 patients (20.0%) with self-limited mild hemoptysis. The final diagnoses of the 43 patients receiving lobectomy were invasive adenocarcinoma (n = 23), pure bronchioloalveolar carcinoma (n = 19), and mucosa-associated lymphoid tissue lymphoma (n = 1). The diagnostic accuracy was 93.0% (40/43) using CT-guided TNB. Pure GGO lesions had a higher incidence of pure bronchioloalveolar carcinoma than GGO-dominant lesions (70.0% versus 21.7%; p = 0.004). Compared with surgical pathology, stromal invasion was underestimated in 43.5% (10/23) of the TNB specimens, especially in pure GGO lesions (83%, 5/6). In logistic regression analysis, the GGO percentage correlated inversely with stromal tumor invasion (p = 0.0028). Conclusions: CT-guided coaxial TNB is a safe and useful method for diagnosing small (<= 3 cm) persistent GGO lesions. Stromal invasion may be underestimated by TNB in GGO lesions.