TY - JOUR T1 - Transthoracic lung biopsy for pulmonary nodules ≤20mm in the routine clinical care JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00562-2021 SP - 00562-2021 AU - Emilie Lissavalid AU - Antoine Khalil AU - Ghassen Soussi AU - Marie-Pierre Debray AU - Alice Guyard AU - Vincent Bunel AU - Raphael Borie AU - Pierre Mordant AU - Aurélie Cazes AU - Gérard Zalcman AU - Valérie Gounant Y1 - 2021/01/01 UR - http://openres.ersjournals.com/content/early/2021/12/02/23120541.00562-2021.abstract N2 - BACKGROUND Computed tomography (CT) screening has improved lung cancer survival, yet increasingly detected small lung lesions. The number of transthoracic lung biopsies (TTLB) for small nodules is thus expected to rise significantly.RESEARCH QUESTION To evaluate the diagnostic accuracy and safety of CT-guided TTLB for nodules ≤20 mm versus nodules >20mm.STUDY DESIGN AND METHODS Data for CT-guided TTLBs from 474 consecutive patients were prospectively collected over a 3-year period (198 lesions ≤20 mm and 276 lesions >20 mm) in a teaching hospital and analysed in terms of diagnostic performance and complications.RESULTS There were more conclusive biopsies in the >20 mm lesion group (n=236; 85.5%) than in ≤20 mm lesion group (n=140; 70.7%; p<0.001). The overall accuracy, sensitivity, specificity, and negative predictive value for diagnosing malignant lesions after first TTLB were 88.4%, 84%, 100%, and 70.1% for ≤20 mm lesions and 94.2%, 93%, 100%, and 74.6% for >20 mm lesions, respectively. Pneumothorax requiring drainage was significantly more common for ≤20 mm lesions, compared to TTLB of larger lesions (9.6% versus 4.3%; p=0.02). Prolonged hospital stay due to pneumothorax occurred in 27 (17.4%) TTLBs of ≤20 mm lesions and 15 (7%) TTLBs of >20mm lesions (p=0.002). There were no deaths. The only variable significantly associated with diagnostic failure in the ≤20mm lesion group was the radiologist's experience.INTERPRETATION TTLBs for lesions ≤20 mm were associated with slightly lower diagnostic performance, whereas the higher rate of major complications was still inferior to that extrapolated from United States insurance databases.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.CONFLICTS OF INTEREST: Emilie Lissavalid, Antoine Khalil, and Ghassen Soussi report no conflicts of interest. Marie-Pierre Debray reports personal fees and non-financial support from Boehringer Ingelheim, Roche, Boston Scientific, all outside the submitted work. Alice Guyard reports personal fees from Diaceutics, all outside the submitted work. Vincent Bunel reports no conflicts of interest. Raphael Borie reports grants and personal fees from Roche, Boerhinger Ingelheim, and Sanofi, all outside the submitted work. Pierre Mordant reports no conflicts of interest. Gérard Zalcman reports personal fees from BMS, MSD, and Boehringer; non-financial support and other from Roche and Astra-Zeneca, as well as other from Abbvie, all outside the submitted work. Valérie Gounant reports personal fees from MSD, Chugai, Novartis, and Boehringer; personal fees and non-financial support from Astra Zeneca, BMS, Takeda, and Pfizer; grants, personal fees, and non-financial support from Roche, all outside the submitted work. Aurélie Cazes reports personal fees from AstraZeneca, Boehringer, and Roche, all outside the submitted work. ER -