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Predictive factors of diagnostic accuracy of CT-guided transthoracic fine-needle aspiration for solid noncalcified, subsolid and mixed pulmonary nodules

Fattori che predicono l’accuratezza diagnostica dell’agobiopsia transtoracica TC-guidata dei noduli polmonari solidi non calcifici, subsolidi e misti

  • Chest Radiology / Radiologia Toracica
  • Published:
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Abstract

Purpose

The aim of this study was to analyse factors predicting the diagnostic accuracy of computed tomography (CT)-guided transthoracic fine-needle aspiration (TTFNA) for solid noncalcified, subsolid and mixed pulmonary nodules, with particular attention to those responsible for false negative results with a view to suggesting a method for their correction.

Materials and methods

From January 2007 to March 2010, we retrospectively reviewed the CT images of 198 patients of both sexes (124 males and 74 females; mean age, 70 years; range age, 44–90) used for the guidance of TTFNA of pulmonary nodules. Aspects considered were: lesion size and density, distance from the pleura, and lesion site. Multiplanar reformatted images (MPR) were retrospectively obtained in the sagittal and axial oblique planes relative to needle orientation.

Results

The overall diagnostic accuracy of TTFNA CTguided biopsy was 86% for nodules between 0.7 and 3 cm, 83.3% for those between 0.7 and 1.5 cm, and 92% for those between 2 and 3 cm. Accuracy was 95.1% for solid pulmonary nodules, 84.6% for mixed nodules, and 66.6% for subsolid nodules. The diagnostic accuracy of CT-guided TTFNA in relation to the distance between the nodule and the pleural plane was 95.6% for lesions adhering to the pleura and 83.5% for central ones. The diagnostic accuracy was 84.2% for the pulmonary upper lobe nodules, 85.3% for the lower lobe and 90.9% for those in the lingula and middle lobe. In 75% of false negative and inadequate/insufficient cases the needle was found to lie outside the lesion, after reconstruction of the needle path by MPR.

Conclusions

The positive predictive factors of CT-guided TTFNA are related to the nodule size, density and distance from the pleural plane. The most common negative predictive factor of CT-guided TTFNA is the wrong position of the needle tip, as observed in the sagittal and axial oblique sections of the MPR reconstructions. The diagnostic accuracy of CT-guided TTFNA can therefore be improved by using the MPR technique to plan the needle path during the FNA procedure.

Riassunto

Obiettivo

Scopo del presente lavoro è stato individuare ed analizzare i fattori che predicono l’accuratezza diagnostica dell’ago-biopsia trans-toracica (TTFNA) guidata da tomografia computerizzata (TC) dei noduli polmonari solidi non calcifici, subsolidi e misti, con particolare attenzione ai fattori responsabili di falsi negativi, proponendo un metodo per la loro correzione.

Materiali e metodi

Tra il 2007 ed il 2010 sono state analizzate retrospettivamente le immagini TC del torace di 198 pazienti di entrambi i sessi (124 maschi e 74 femmine, età media 70 anni, range età 44–90) utilizzate per l’esecuzione di TTFNA TC-guidata di noduli polmonari. I criteri analizzati sono stati: dimensione, densità, distanza dal piano pleurico e sede dei noduli polmonari. Sono state ottenute retrospettivamente immagini in ricostruzioni multiplanari (MPR) sui piani sagittali ed asssiali obliqui in relazione all’orientamento dell’ago.

Risultati

L’accuratezza complessiva della TTFNA TC-guidata per noduli polmonari compresi tra 0,7 e 3 cm è stata 86%. L’accuratezza per i noduli polmonari compresi tra 7 e i 15 mm è stata del 83,3%, per quelli compresi tra 20 e 30 mm del 92%. L’accuratezza per i noduli polmonari solidi è stata del 95%, per i noduli misti 84,6% e per noduli subsolidi 66,6%. L’accuratezza per i noduli adesi al piano pleurico è stata del 95,6% e per quelli centrali 83,5%. Per i noduli dei lobi superiori è stata 84,2%, per quelli dei lobi inferiori 85,3%, per quelli della lingula e del lobo medio 90,9%. Nel 75% dei casi falsi negativi, inadeguati o insufficienti, la punta dell’ago dopo ricostruzione MPR era localizzata all’esterno o in periferia del nodulo polmonare.

Conclusioni

I fattori diagnostici predittivi positivi della TTFNA TC-guidata sono correlati con le dimensioni, la densità e la distanza del nodulo polmonare con il piano pleurico. Il fattore predittivo negativo ricorrente della TTFNA TC-guidata è l’errata localizzazione della punta dell’ago, mal evidente nelle scansioni assiali native, osservata retrospettivamente nelle sezioni sagittali ed assiali oblique MPR. Il ricorso alle immagini MPR sagittali e assiali oblique durante l’agoaspirazione è utile per il corretto planning della traiettoria dell’ago, quest’ultimo aspetto cruciale che influenza l’accuratezza diagnostica della procedura.

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Authors and Affiliations

  1. Radiology Unit, University of Parma, Parma Hospital, Via Gramsci 14, 43100, Parma, Italy

    Massimo De Filippo, Luca Saba, Giorgio Concari, Nicola Sverzellati, Ilaria Paladini, Chiara Ganazzoli & Cristina Rossi

  2. Department of Oncology, University of Parma, Parma Hospital, Via Gramsci 14, 43100, Parma, Italy

    Rita Nizzoli, Marcello Tiseo & Andrea Ardizzoni

  3. Pneumology Unit, University of Parma, Parma Hospital, Via Gramsci 14, 43100, Parma, Italy

    Lilia Ferrari

  4. Radiology Unit, IRCCS Policlinico San Donato, Piazza E. Malan 2, 20097, San Donato Milanese, Milan, Italy

    Luca Maria Sconfienza

  5. Radiology Unit, University Hospital, Varese Hospital, Viale Borri 57, 21100, Varese, Italy

    Giampaolo Carrafiello

  6. Medicine and Health Sciences Unit, Molise University, Campobasso, Italy

    Luca Brunese

  7. Medical Sciences Unit, Cagliari University Hospital, Cagliari, Italy

    Eugenio Annibale Genovese

  8. Thoracic Surgery Unit, University of Parma, Parma Hospital, Via Gramsci 14, 43100, Parma, Italy

    Luca Ampollini, Paolo Carbognani & Michele Rusca

  9. Radiology Unit, S. Orsola University Hospital, Via Massarenti 9, 40138, Bologna, Italy

    Maurizio Zompatori

  10. Unità Operativa di Scienze Radiologiche, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy

    Massimo De Filippo

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  1. Massimo De Filippo
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  2. Luca Saba
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  13. Luca Brunese
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  14. Eugenio Annibale Genovese
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  19. Cristina Rossi
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Correspondence to Massimo De Filippo.

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De Filippo, M., Saba, L., Concari, G. et al. Predictive factors of diagnostic accuracy of CT-guided transthoracic fine-needle aspiration for solid noncalcified, subsolid and mixed pulmonary nodules. Radiol med 118, 1071–1081 (2013). https://doi.org/10.1007/s11547-013-0965-4

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  • DOI: https://doi.org/10.1007/s11547-013-0965-4

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