Christopher Mallow1, Hans Lee1, Catherine Oberg2, Jeffrey Thiboutot1, Jason Akulian3, Allen C Burks4, Branden Luna5, Sadia Benzaquen6, Hitesh Batra7, Jose Cardenas-Garcia8, Jennifer Toth9, Jay Heidecker10, Adam Belanger3, Jason McClune9, Umar Osman11, Venkatesh Lakshminarayanan12, Nicholas Pastis5, Gerard Silvestri5, Alexander Chen4, Lonny Yarmus1. 1. Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 2. Division of Pulmonary and Critical Care Medicine, Ichan School of Medicine at Mount Sinai, New York, NY, USA. 3. Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA. 4. Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA. 5. Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA. 6. Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA. 7. Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA. 8. Division of Pulmonary and Critical Care Medicine, University of Michigan School, Ann Arbor, MI, USA. 9. Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA. 10. Division of Pulmonary Medicine, Birmingham Pulmonary Group, Birmingham, AL, USA. 11. Division of Pulmonary and Critical Care Medicine, Memorial Health System, Marietta, OH, USA. 12. Division of Pulmonary and Critical Care Medicine, Pulmonary and Critical Care of Atlanta, Atlanta, GA, USA.
Abstract
BACKGROUND AND OBJECTIVE: Percutaneous lung biopsy for diagnostic sampling of peripheral lung nodules has been widely performed by interventional radiologists under computed tomography (CT) guidance. New technology allows pulmonologists to perform percutaneous lung biopsies using electromagnetic (EM) guided technology. With the adoption of this new technique, the safety, feasibility and diagnostic yield need to be explored. The goal of this study was to determine the safety, feasibility and diagnostic yield of EM-guided percutaneous lung biopsy performed by pulmonologists. METHODS: We conducted a retrospective, multicentre study of 129 EM-guided percutaneous lung biopsies that occurred between November 2013 and March 2017. The study consisted of seven academic and three community medical centres. RESULTS: The average age of participants was 65.6 years, BMI was 26.3 and 50.4% were females. The majority of lesions were in the right upper lobe (37.2%) and left upper lobe (31.8%). The mean size of the lesions was 27.31 mm and the average distance from the pleura was 13.2 mm. Practitioners averaged two fine-needle aspirates and five core biopsies per procedure. There were 23 (17.8%) pneumothoraces, of which 16 (12.4%) received small-bore chest tube placement. The diagnostic yield of percutaneous lung biopsy was 73.7%. When EM-guided bronchoscopic sampling was also performed during the same procedural encounter, the overall diagnostic yield increased to 81.1%. CONCLUSION: In this large multicentred series, the use of EM guidance for percutaneous lung biopsies was safe and feasible, with acceptable diagnostic yield in the hands of pulmonologists. A prospective multicentre trial to validate these findings is currently underway (NCT03338049).
BACKGROUND AND OBJECTIVE: Percutaneous lung biopsy for diagnostic sampling of peripheral lung nodules has been widely performed by interventional radiologists under computed tomography (CT) guidance. New technology allows pulmonologists to perform percutaneous lung biopsies using electromagnetic (EM) guided technology. With the adoption of this new technique, the safety, feasibility and diagnostic yield need to be explored. The goal of this study was to determine the safety, feasibility and diagnostic yield of EM-guided percutaneous lung biopsy performed by pulmonologists. METHODS: We conducted a retrospective, multicentre study of 129 EM-guided percutaneous lung biopsies that occurred between November 2013 and March 2017. The study consisted of seven academic and three community medical centres. RESULTS: The average age of participants was 65.6 years, BMI was 26.3 and 50.4% were females. The majority of lesions were in the right upper lobe (37.2%) and left upper lobe (31.8%). The mean size of the lesions was 27.31 mm and the average distance from the pleura was 13.2 mm. Practitioners averaged two fine-needle aspirates and five core biopsies per procedure. There were 23 (17.8%) pneumothoraces, of which 16 (12.4%) received small-bore chest tube placement. The diagnostic yield of percutaneous lung biopsy was 73.7%. When EM-guided bronchoscopic sampling was also performed during the same procedural encounter, the overall diagnostic yield increased to 81.1%. CONCLUSION: In this large multicentred series, the use of EM guidance for percutaneous lung biopsies was safe and feasible, with acceptable diagnostic yield in the hands of pulmonologists. A prospective multicentre trial to validate these findings is currently underway (NCT03338049).