CT-guided percutaneous fine-needle aspiration biopsy of small (< or =1-cm) XXXX .

@entity1 @entity358 @entity5
PURPOSE: To determine the accuracy of percutaneous computed tomography (CT)-guided fine-needle aspiration biopsy (FNAB) of small (< or =1.0-cm in diameter) @entity358 . MATERIALS AND METHODS: Sixty-one @entity1 (34 @entity1 and 27 @entity1 ) 21-89 years old (mean age, 61.3 years) with lung nodules 1.0 cm or smaller underwent CT-guided transthoracic FNAB. Fifty-seven of the 61 @entity1 had an underlying primary @entity5 . Maximum nodule diameters were 0.5-0.7 cm in 10 @entity1 and 0.8-1.0 cm in 51 @entity1 . Cytopathologic evaluation of FNAB samples was immediate in all @entity1 . Sensitivity and accuracy were calculated, and each case was reviewed for complications, including pneumothorax and thoracostomy tube insertion. Four @entity1 were not included in our statistical analysis because of a lack of follow-up information. RESULTS: FNAB samples were adequate for diagnosis in 47 (77%) of 61 @entity1 . Diagnoses were @entity5 (n = 29) or suspected @entity5 (n = 3) in 52% (n = 32) and benign or atypical findings in 25% (n = 15). Findings were nondiagnostic in 23% (n = 14). Of the 29 @entity1 without evidence of @entity5 , 25 had follow-up findings available. Follow-up included chest CT in 16 @entity1 and surgical resection in nine. Four @entity1 were not included in statistical analysis because of a lack of follow-up information. Overall sensitivity was 82% (32 of 39); specificity, 100% (18 of 18); and diagnostic accuracy, 88% (50 of 57) on the basis of 57 @entity1 being evaluable. Results for 47 0.8-1.0-cm lesions were considerably better (sensitivity, 88%; accuracy, 92%) than those for 10 0.5-0.7-cm lesions (sensitivity, 50%; accuracy, 70%). Sensitivity (75% vs 87%) and accuracy (87% vs 89%) also improved when comparing subpleural (< or =1.0 cm from pleural surface, n = 30) with deeper (>1 cm from pleural surface, n = 27) @entity358 , but the improvement did not indicate statistical significance. Core biopsy did not reveal @entity5 in any of the nine @entity1 in whom preliminary cytologic results were inconclusive and did not improve diagnostic yield. Thirty-eight (62%) @entity1 had pneumothorax, with 19 (31%) requiring thoracostomy tube placement. CONCLUSION: CT-guided FNAB of @entity358 1.0 cm or smaller can yield high diagnostic accuracy rates approaching those of larger lesions; FNAB of 0.8-1.0-cm lesions that are not subpleural offers the best opportunity for success.
