CT-guided Core-Needle Biopsy of the Lung Is Safe and More Effective than Fine-Needle Aspiration Biopsy in Patients with Hematologic Malignancies

To evaluate the safety and diagnostic yield of CT-guided core-needle biopsy (CNB) versus fine-needle aspiration biopsy (FNAB) of lung nodules and masses in patients with hematologic malignancies (HMs). With institutional review board approval, 166 patients were retrospectively reviewed between 2007 and 2017 who were diagnosed with leukemia, lymphoma, or myelodysplastic syndromes (with or without hematopoietic stem cell transplant) and who underwent CT-guided FNAB and/or CNB of the lung. Patient medical records, pathologic reports, and interventional biopsy reports were reviewed. In the study period, 166 patients underwent percutaneous CT-guided lung biopsy; 36% (60 of 166) of the procedures included CNB (CNB + FNAB and CNB only), whereas 64% (106 of 166) were FNAB only. In the CNB group, FNAB was also performed for 92% (55 of 60) of the patients before CNB; 13% (eight of 60) of patients in the CNB group were nondiagnostic versus 45% (48 of 106) of FNAB only ( < .0001). There was no statistically significant difference in the pulmonary complication rates, with 1.7% of CNB and 1.9% of FNAB only requiring chest tube placement ( = .7), 5% of CNB and 2.8% of FNAB only developing hemoptysis ( = .4), and 5% of CNB and 2% of FNAB only developing hemothorax ( = .3). A change in clinical management was observed in 51% of patients with diagnostic biopsies compared with 21% of patients with nondiagnostic biopsies ( = .0002). CT-guided CNB is an effective technique for performing lung biopsy in patients with HMs with higher diagnostic yield compared with FNAB, and a higher, although not a statistically significant, increased risk of bleeding complications and pneumothorax.© RSNA, 2019See also the commentary by Elicker in this issue.