Original Article

CT-guided fine-needle aspiration biopsy of solitary pulmonary nodules under 15 mm in diameter: time for an afterthought?

Davide Tosi, Paolo Mendogni, Rosaria Carrinola, Alessandro Palleschi, Lorenzo Rosso, Eleonora Bonaparte, Fulvia Milena Cribiù, Stefano Ferrero, Gianluca Bonitta, Mario Nosotti


Background: Many studies on fine-needle aspiration biopsy (FNAB) for undetermined pulmonary nodules reported that diagnostic accuracy tended to decline, whereas complication prevalence raised as the size of nodule decreased. Reconsideration on the effectiveness of FNAB would be appropriate considering the dramatic increase in the identification of small nodules with screening programs and new demands of target therapies. The aim of this study was to verify the efficacy of FNAB in pulmonary nodules smaller than 15 mm.
Methods: A retrospective, cohort study was conducted on patients with undetermined solitary pulmonary nodules (SPNs) who underwent computer tomography (CT) guided FNAB at our Institution from January 2012 to December 2014. Patients with SPNs with diameter up to 15 mm were considered; inclusion criteria comprised ASA 3, FEV1 <70% of predicted, cardiac comorbidity or previous chest surgery. FNAB diagnostic performance and clinical efficacy were calculated.
Results: Out of 225 patients referred for FNAB, 68 covered inclusion criteria. The cohort’s prevalence of malignant pathology was 61%. Forty-nine out of 68 smears (72%) were adequate for diagnosis. Specificity was 100% (95% CI: 75–100%), sensitivity was 97.2% (95% CI: 86–100%). Positive and negative predictive values were 83% and 100%. A post-biopsy pneumothorax was detected in 27 cases (39%); the pneumothorax rate was significantly affected by the number of passages (P=0.01). Sixteen patients (23%) avoided unnecessary surgery.
Conclusions: The satisfactory results of our study lead to reconsidering FNAB in patients with pulmonary nodules below 15 mm in diameter, especially in order to avoid unnecessary surgery.

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