Adequacy of Transthoracic Needle Biopsy Samples in the Diagnosis of a Peripheral Lung Lesion – Comparing Success Rates of Various Imaging Modalities

The aim of the study was to test whether a difference in the imaging modality (CT, Fluoroscopy, or Ultrasound) would result in a higher biopsy success rate for the diagnosis of lung cancer. A total of 144 transthoracic needle biopsies performed under guidance of different imaging modalities were retrospectively reviewed at King Abdulaziz Medical city in Riyadh between 2008 and 2012. A biopsy was counted a success whenever a definitive diagnosis could be achieved. CT guided biopsies revealed 51 successes out of 86 total samples, fluoroscopy guided biopsies revealed 8 successes out of 20 total samples, while for ultrasound guided biopsies, 30 successes out of 38 biopsies gave a definitive diagnosis. Comparing CT guided biopsies vs. Fluoroscopy guided biopsies, we got a p-value of 0.1884 which is clinically insignificant, 95% Confidence Interval [-0.07628, 0.46233]. On comparison of CT guided biopsies vs. ultrasound guided biopsies the p-value was 0.05558 which is also clinically insignificant, 95% Confidence Interval [-0.38150, -0.011399]. When ultrasound guided biopsies were compared to the fluoroscopy guided biopsies a p-value of 0.007461 < 0.025 was achieved which is clinically highly significant, 95% Confidence Interval [-0.38150, -0.011399]. It was determined with 95% confidence that there is a clinically significant difference (p-value of 0.007461) between success rates of Fluoroscopy guided biopsies and ultrasound guided biopsies, but not between the other pairs of modalities. Further investigations with larger sample size are warranted to compare the efficacy of fluoroscopy and ultrasound based imaging modalities for transthoracic needle biopsy.