The problems in conformity of lung tumors challenge the health practitioners, particularly pulmonologists, in diagnosing the tumor. Generally, patients who are admitted to the hospital are in an advanced stage and physically limited in conducting the invasive diagnostic procedure. Currently, fine needle specimen collection (FNAB) no longer meets the need for a lung tumor diagnosis. In several cases, there are limitations and weaknesses where the cytological samples of FNAB material are not sufficient to determine the diagnosis of lung tumors. Therefore, patients should receive the other diagnostic procedure through core needle biopsy (CNB) or open biopsy.
CNB is a procedure for taking a sample of tumor tissue using a hollow core needle between 11-16 gauges to collect a sample of cells to be examined under a microscope. In the personalized medicine era, it is necessary to use a technique to diagnose the lung tumor with a sufficient amount of specimens for histopathology and immunohistochemical examinations. Therefore, this research objective is to analyze the conformity of anatomical pathology results between fine-needle aspiration biopsy (FNAB) and core needle biopsy (CNB) materials in peripheral lung tumors.
Participants of this research were lung tumor patients who met the inclusion and exclusion criteria, which are the patients with peripheral lung tumors based on chest X-rays, ultrasound, and CT scans and those who could perform a percutaneous biopsy using thoracic ultrasound guidance. While the exclusion criteria include patients with a performance score of
Most participants were male (81.8%), aged >50 years (77.3%), with most respiratory symptoms being chronic cough (63.6%). Most tumors were located in the right lung (62.1%) and most were in the right superior lobe (34.8%). Most participants had a needle inserted in the anterior (66.7%). Most tumors sized >70 mm as much as 39.4%, and the majority of participants did not experience post-FNAB and CNB complications. Most participants had two punctures in each technique (FNAB = 93.9% and CNB = 63.6%). In both groups, the results of anatomical malignancy were found FNAB of 57.6% and CNB of 71.2%. Materials in both groups were declared adequate with an FNAB of 72.7% and a CNB of 89.4%. This research found no correlation between age, lesion size, and the number of FNAB needle passes on the incidence of complications. A study conducted by Capalbo reported age as a factor that affects complications, with the incidence of pneumothorax due to CNB, reported to be the majority in young patients, parenchymal bleeding in the elderly, and complications frequently occur in the right lung. Fifty percent of pneumothorax cases occur in the superior lobe of the lung on the CNB technique, and 40% of parenchymal hemorrhages in the inferior lobe on FNAB. In terms of size, the CNB technique is more complicated than the FNAB in lesions sized less than 3.5 cm. However, unlike our study, Capalbo’s was not performed at the same time as a biopsy so there was no detail provided regarding the incidence of complications of each technique. Parameters related to complications were needle access, lesion size, age, needle diameter, and needle passes. In terms of age, pulmonary parenchymal bleeding and complications of hemoptysis were more common in the elderly who underwent CNB, probably because they usually used anticoagulant therapy because of comorbidities. There was no significant correlation between the number of needles injected with complications and diagnostic accuracy because the average success was in a single puncture, in contrast to other studies that reported pneumothorax will occur more often in those who undergo many needles passes because this can cause a lot of trauma to the pleura or so that coaxial needle is needed in the future.
The study revealed that taking specimens with a core biopsy is more sufficient for tissue needs. There is a significant correlation between more than two CNB needle passes and the incidence of complications. CNB can detect anatomical malignancy and specimen adequacy better than FNAB.
Title: Conformity of Fine Needle Aspiration Biopsy (FNAB) and Core Needle Biopsy (CNB) in peripheral lung tumor patients: A cross-sectional study
Authors: Isnin Anang Marhana, Kadek Widianiti, Etty Hary Kusumastuti
Source: https://www.sciencedirect.com/science/article/pii/S2049080122001832
