Comparison of Computed Tomography-Guided Transthoracic Core-Needle Biopsy and Fine-Needle Aspiration Biopsy Regarding Diagnostic Yield, Complications, and Molecular Testing Adequacy in Lung Cancer

Vollständiger Abstract

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Abstract Computed tomography (CT)-guided core-needle biopsy (CNB) and fine-needle aspiration biopsy (FNA) are widely used to diagnose lung cancer. With the increasing need for molecular testing, this study compared these methods concerning diagnostic yield, complications, and adequacy for mutation analysis. The present retrospective study included 304 patients (FNA: 214, CNB: 90) who underwent CT-guided biopsy between January 2021 and December 2023 at a single institution. Diagnostic yield, molecular adequacy (100–200 tumor cells), complications, and lesion characteristics (size, location, parenchymal distance traversed) were analyzed. A specific diagnosis was reached in 94.3% of FNA cases and 94.4% of CNB cases. For primary lung adenocarcinoma or nonsmall-cell carcinoma, adequate tissue was available to perform molecular studies in 98% of FNA and 96% of CNB cases. Both during and after biopsy, the most common complications were pneumothorax (FNA: 9.3%; CNB: 12.2%) and parenchymal hemorrhage (FNA: 2.8%; CNB: 11.1%). No statistical difference was found among the two procedures for reaching a specific diagnosis according to Fisher's exact test results (p = 0.986), or obtaining sufficient tissue for molecular studies (p = 0.166). Smaller lesion size and greater parenchymal distance traversed were linked to pneumothorax in univariate analysis, whereas no relationship was observed for biopsy technique. In multivariable analysis, biopsy technique and lesion size were not independent predictors. The parenchymal distance traversed remained significant (odds ratio = 1.03; p = 0.003), with each 1 mm increase raising pneumothorax risk by approximately 3%. Both methods displayed high diagnostic yield, adequacy for molecular studies, and the potential to reduce the need for invasive diagnostic surgical procedures.