20G ve 22G İğnelerin BT Kılavuzluğunda Transtorasik İnce İğne Aspirasyon Biyopsisinde Etkinliği ve Güvenliği

Öz

Amaç: Bu çalışma, transtorasik ince iğne aspirasyon biyopsisinde (TTİİAB) 20G ve 22G iğnelerin tanısal doğruluk ve komplikasyon oranlarını karşılaştırmayı amaçlamaktadır. Yöntem: Bu retrospektif çalışmada, Ocak 2018 ile Mart 2020 arasında bilgisayarlı tomografi (BT) eşliğinde gerçekleştirilen transtorasik akciğer biyopsisi sonuçları incelendi. Toplamda 127 hastaya BT kılavuzluğunda TTİİAB kullanılarak 20G veya 22G iğnelerle biyopsi yapıldı. Biyopsi yapılan olgularda lezyon boyutu, lokalizasyonu, tanısal yeterlilik ve komplikasyonlar hakkında veriler toplandı ve analiz edildi. Bulgular: Çalışmaya dahil edilen hastaların yaş ortalaması 63,21 yıl olup, toplamda 127 hasta mevcuttu. Bu hastalardan 72'sine 22G iğne ile, 55'ine ise 20G iğne ile biyopsi yapıldı. Genel tanısal doğruluk %96,8 olup, 20G ve 22G iğne grupları arasında tanısal doğruluk açısından anlamlı fark bulunmamıştır (p=0,206). Komplikasyonlar 59 hastada (%46,5) görülmüş olup, en yaygın komplikasyon pnömotorakstır. Pnömotoraks oranı %22,8 olup, iki vakada göğüs tüpü yerleştirilmiştir. İkinci en sık komplikasyon pulmoner hemoraji olup, %18,9 oranında görülmüştür. İğne boyutları arasında komplikasyon oranları açısından anlamlı bir fark bulunmamıştır (p=0,985). Sonuç: BT kılavuzluğunda TTİİAB, 20G ve 22G iğneler kullanılarak güvenli ve etkili şekilde gerçekleştirilebilmekte olup, yüksek tanısal doğruluk ve düşük komplikasyon oranlarına sahiptir. İğne boyutu seçimi, tanısal sonuçları veya komplikasyon oranlarını etkilememektedir.

Anahtar Kelimeler

• Biyopsi
• pnömotoraks
• bilgisayarlı tomografi
• transtorasik biyopsi
• ince iğne aspirasyon biyopsisi
• tanısal doğruluk
• komplikasyonlar
• akciğer kitlesi
• iğne boyutu

Efficacy and Safety of 20G vs. 22G Needles in CT-Guided Transthoracic Fine Needle Aspiration Biopsies

Öz

Aim: This study aims to compare the diagnostic accuracy and complication rates of 20G and 22G needles in transthoracic fine needle aspiration biopsy (TFNAB). Method: This retrospective study reviewed lung biopsy results from procedures performed between January 2018 and March 2020. Patients included had non-diagnostic bronchoscopic biopsies or were deemed inappropriate for bronchoscopic biopsy. A total of 127 patients underwent Computed tomography (CT) guided TFNAB using either 20G or 22G needles. Data on lesion size, localization, diagnostic adequacy, and complications were collected and analyzed. Results: The study cohort included 127 patients with a mean age of 63.21 years. Of these, 72 underwent biopsies with a 22G needle and 55 with a 20G needle. The overall diagnostic accuracy was 96.8%, with no significant differences between the 20G and 22G needle groups (p=0.206). Complications occurred in 59 patients (46.5%), with pneumothorax being the most common, and two cases required chest tube placement. The rate of pulmonary hemorrhage was 18.9%. There were no significant differences in complication rates between the needle sizes (p=0.985). Conclusion: CT-guided TFNAB using both 20G and 22G needles is safe and effective, with high diagnostic accuracy and low complication rates. The choice of needle size does not significantly impact diagnostic outcomes or complication rates, allowing clinicians flexibility based on patient-specific factors and procedural requirements.

Anahtar Kelimeler

• Biopsy
• pneumothorax
• computed tomography
• transthoracic biopsy
• fine-needle aspiration biopsy
• diagnostic accuracy
• complications
• lung mass
• needle gauge

Kaynakça

1. 1. Boskovic T, Stanic J, Pena-Karan S, et al. Pneumothorax after transthoracic needle biopsy of lung lesions under CT guidance. J Thorac Dis. 2014;6 Suppl 1(Suppl 1):S99-S107. doi: 10.3978/j.issn.2072-1439.2013.12.08.
2. 2. Chen CK, Chang HT, Chen YC, Chiang SC, Chou HP, Chen TJ. Utilization and safety of percutaneous lung biopsy: A 10-year nationwide population-based study. Int J Environ Res Public Health. 2019;16(8):1316. doi: 10.3390/ijerph16081316.
3. 3. Unver E, Yilmaz A, Aksoy F, et al. Does needle size affect diagnostic yield of transthoracic needle biopsy in malignant pulmonary lesions? Comparison of 18-, 22- and 25-gauge needles in surgical specimens [published correction appears in Respirology. 2007;12(1):157. [corrected to Celik, O]]. Respirology. 2006;11(5):648-651. doi:10.1111/j.1440-1843.2006.00901.x.
4. 4. Weisbrod GL. Transthoracic percutaneous lung biopsy. Radiol Clin North Am. 1990;28(3):647-655.
5. 5. Lucidarme O, Howarth N, Finet JF, Grenier PA. Intrapulmonary lesions: Percutaneous automated biopsy with a detachable, 18-gauge, coaxial cutting needle. Radiology. 1998;207(3):759-765. doi: 10.1148/radiology.207.3.9609901.
6. 6. Nair AV, Anirudh S, Moorthy S, Cyril P, Rajamma BM, Ramachandran PV. CT-guided lung fine needle aspiration biopsy: Analysis of efficacy, yield and intricacies. Indian J Med Paediatr Oncol. 2018;39(2):250-253.
7. 7. Esakov YS, Shrainer IV, Kirpichnikova EI, et al. Klinicheskaya effektivnost' transtorakal'noi biopsii perifericheskikh novoobrazovanii legkikh pod kontrolem MSKT [Clinical efficacy of CT-guided transthoracic needle biopsy of peripheral lung lesions]. Khirurgiia (Mosk). 2022;(5):34-42. doi: 10.17116/hirurgia202205134.
8. 8. Takeshita J, Masago K, Kato R, et al. CT-guided fine-needle aspiration and core needle biopsies of pulmonary lesions: A single-center experience with 750 biopsies in Japan. AJR Am J Roentgenol. 2015;204(1):29-34. doi: 10.2214/AJR.14.13151.

9. 9. Geraghty PR, Kee ST, McFarlane G, Razavi MK, Sze DY, Dake MD. CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. Radiology. 2003;229(2):475-481. doi: 10.1148/radiol.2291020499.
10. 10. Priola AM, Priola SM, Cataldi A, et al. Diagnostic accuracy and complication rate of CT-guided fine needle aspiration biopsy of lung lesions: A study based on the experience of the cytopathologist. Acta Radiol. 2010;51(5):527-533. doi: 10.3109/02841851003691979.
11. 11. Laurent F, Latrabe V, Vergier B, Michel P. Percutaneous CT-guided biopsy of the lung: comparison between aspiration and automated cutting needles using a coaxial technique. Cardiovasc Intervent Radiol. 2000;23(4):266-272. doi: 10.1007/s002700010067.
12. 12. Uzun Ç, Akkaya Z, Düşünceli Atman E, et al. Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy of pulmonary lesions with non-coaxial technique: A single center experience with 442 biopsies. Diagn Interv Radiol. 2017;23(2):137-143.
13. 13. Heerink WJ, de Bock GH, de Jonge GJ, Groen HJ, Vliegenthart R, Oudkerk M. Complication rates of CT-guided transthoracic lung biopsy: Meta-analysis. Eur Radiol. 2017;27(1):138-148. doi: 10.1007/s00330-016-4357-8.
14. 14. Yeow KM, Tsay PK, Cheung YC, Lui KW, Pan KT, Chou AS. Factors affecting diagnostic accuracy of CT-guided coaxial cutting needle lung biopsy: Retrospective analysis of 631 procedures. J Vasc Interv Radiol. 2003;14(5):581-588. doi: 10.1097/01.rvi.0000071087.76348.c7.
15. 15. Khan MF, Straub R, Moghaddam SR, et al. Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy. Eur Radiol. 2008;18(7):1356-1363. doi: 10.1007/s00330-008-0893-1.
16. 16. Covey AM, Gandhi R, Brody LA, Getrajdman G, Thaler HT, Brown KT. Factors associated with pneumothorax and pneumothorax requiring treatment after percutaneous lung biopsy in 443 consecutive patients. J Vasc Interv Radiol. 2004;15(5):479-483. doi: 10.1097/01.rvi.0000124951.24134.50.
17. 17. Kuban JD, Tam AL, Huang SY, et al. The effect of needle gauge on the risk of pneumothorax and chest tube placement after percutaneous computed tomographic (CT)-guided lung biopsy. Cardiovasc Intervent Radiol. 2015;38(6):1595-1602.
18. 18. Cox JE, Chiles C, McManus CM, Aquino SL, Choplin RH. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Radiology. 1999;212(1):165-168.
19. 19. Yeow KM, Su IH, Pan KT, et al. Risk factors of pneumothorax and bleeding: Multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies. Chest. 2004;126(3):748-754. doi: 10.1378/chest.126.3.748.
20. 20. Richardson CM, Pointon KS, Manhire AR, Macfarlane JT. Percutaneous lung biopsies: A survey of UK practice based on 5444 biopsies. Br J Radiol. 2002;75(897):731-735. doi: 10.1259/bjr.75.897.750731.