Abstract
Purpose This study aims to assess the significance of imaging techniques and needle thickness employed in transthoracic core needle biopsy for determining the cancer type and subtypes, ultimately guiding the treatment of lung cancer. Material and methods Between 2018 and 2023, a cohort of 350 patients (69.7% male, 30.3% female) underwent CT-guided lung biopsy, predominantly utilizing core biopsies. Fine needle aspiration biopsies employed 18 or 20 G Chiba needles, while core needle biopsies utilized 16 or 18-gauge coaxial system semi-automatic needles. The preferred needle and biopsy sample size were 16 G in thickness and 2 cm in length. Pre-procedure positron emission tomography-computed tomography (PET-CT) images aided in identifying the most homogenous lesion with the highest SUV max value, guiding biopsy sample extraction. Post-procedure control CT evaluated complications according to the Society of Interventional Radiology (SIR) reporting standard. Results The average age of biopsied patients was 65.48 +/- 12.32 SD (range: 18-90). Tru-cut biopsy was predominant (69.7%), utilizing a larger number of 16G needles. Pathological diagnoses were mostly malignant (76.6%), with lesion sizes averaging 35.98 +/- 17.90 SD (range: 5-105 mm) and distances to pleura averaging 13.48 +/- 13.54 SD (range: 0-86 mm). Malignancy prevalence was higher in males (56.8%), tru-cut biopsies (72.7%), 16G needles used for tru-cut (47.7%), and PET-CT evaluation (59.1%). Complications were identified in 22% of cases, with distance to pleura significantly associated (p < 0.001). No significant differences in complication risk were observed between FNAB and tru-cut and between needle gauges (20 G-18 G and 16 G) (p: 0.734, p: 0.638, respectively). Conclusion The study underscores the paramount importance of biopsy sample size in diagnosing lung cancers and determining targeted therapy. Optimal biopsy localization, informed by pre-procedure imaging techniques, is crucial. Hence, the recommendation is to utilize the thickest needles and largest samples for lung biopsies.