30. Biópsia transtorácica guiada por tac: estudo de 102 biópsias

The authors present a review of the CT-guided biopsies performed in the Radiology Department of Centro Hospitalar de Coimbra (CHC) during a four year period (March 1999-March 2003), with the purpose of evaluating the type and location of lesions and the diagnostic yield, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and complications of the procedure.We performed 155 biopsies in 152 patients. After reviewing the clinical files, the images, image reports and pathology reports, only 102 biopsies (99 patients) were included in the study group; the remaining were excluded due to lack of information.67 (65,69%) biopsies were performed on male and 35 (34,31%) on female patients, with an age average of 66,7years (24-93). 58 biopsies were requested by the Pneumology Department of CHC and the remaining (44) by other hospitals. Of the 102 lesions, 56 (54,90%) were masses, 31 (30,39%) nodules and 15 (14,71%) condensations, with 22 (21,57%) localized in the right upper lobe, 2 (1,96%) in the medium lobe, 17 (16,67%) in the right lower lobe, 18 (17,56%) in the left upper lobe and 9 (8,82%) in the left lower lobe. 9 (8,82%) lesions occupied more than one lobe, 9 (8,82%) lesions were in the pleura/chest wall and 3 (2,94%) were mediastinal; it was not possible to determine the lesion location in 13 cases (12,75%).A 18G-cutting needle was used for the majority of biopsies, yieldind a single fragment. The pathological/citological examination demonstrated that 65 cases (63,72%) were neoplasic and 16 (15,69%) nonneoplasic. In 21 lesions (20,59%) the sample obtained was inconclusive/insuficient for diagnosis. For the 3 patients that repeated the biopsy, the histological diagnosis was obtained in the second attempt.The overall diagnostic yield was 79,41% and 86,87% for neoplasic lesions. Of the 102 biopsies performed we could only obtain diagnostic confirmation (clinical or by surgery) in 66, 55 of which were neoplasic and 11 nonneoplasic. The sensitivity, specificity, PPV and NPV for neoplasic lesions was 78,18%, 100%, 100% and 47,82% respectively.The complication rate was 7,84% (8 cases: hemorrage in 6 and pneumothorax in 2, neither of which required drainage).The results obtained, confirm that CT-guided transthoracic biopsy is an accurate technique for the diagnosis of intrathoracic lesions, sparing patients from VATS or thoracotomy in many instances. The low rate of complications together with the fact that it can be performed in an out-patient basis, make it an important technique in pneumology