Small (≤2-cm) subpleural pulmonary lesions: Short-versus long-needle-path CT-guided biopsy - Comparison of diagnostic yields and complications

PURPOSE: To retrospectively compare the diagnostic yield and complications associated with the use of short versus long needle paths for computed tomography (CT)-guided biopsy of small subpleural lung lesions. MATERIALS AND METHODS: The study was approved by the institutional review board, and the requirement for informed patient consent was waived. The medical and imaging records of patients who underwent CT-guided biopsy of subpleural pulmonary nodules measuring up to 2 cm in diameter were reviewed. The study included 176 patients (79 men, 97 women; age range, 18-84 years) who were divided into two groups: In group A, a direct approach in which the needle traversed a short lung segment was used. In group B, an indirect approach involving the use of a longer needle path was used. Diagnostic yield, accuracy, and pneumothorax and chest tube placement rates were compared between the two groups. Two-tailed t tests and Pearson χ² tests were used to analyze continuous and categorized variables, respectively. RESULTS: Group A comprised 48 patients; and group B, 128 patients. The mean needle path length was 0.4 cm in group A and 5.6 cm in group B. The short-path approach necessitated more needle punctures (mean, 2.9 vs 1.8 with long-path approach, P < .001) through the pleura. The diagnostic yield in group A was significantly lower than that in group B (71% vs 94%, P < .001), particularly in patients with small (0-1-cm) nodules (40% in group A vs 94% in group B, P < .001). The frequency of postbiopsy pneumothorax was identical (69%) in the two groups. However, more group B than group A patients required chest tube placement for treatment of pneumothorax (38% vs 17%, P = .006). CONCLUSION: Use of long-needle-path biopsy of subpleural lesions resulted in a higher diagnostic yield, especially for small nodules. However, compared with the short-needle-path technique, this approach was associated with a higher frequency of chest tube placement for pneumothorax.