Utility of Percutaneous Lung Nodule Biopsy in Patients with Known Non-Lung Primary Malignancy

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

Su-Yuan Yu, BS (she/her/hers)

Medical Student
University of South Florida Morsani College of Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

AR

Anupam Rishi, MD

resident
Moffitt Cancer Center
ES

Elias Salloum, MD

Assistant Member in the Department of Diagnostic Imaging and Interventional Radiology
Moffitt Cancer Center
Altan Ahmed, MD

Assistant Member, Department of Diagnostic Imaging and Interventional Radiology
H. Lee Moffitt Cancer Center & Research Institute
Hakob Kocharyan, MD

Assistant Member, Department of Diagnostic Imaging and Interventional Radiology
Moffitt Cancer Center
JC

Junsung Choi, MD

SR MBR DIAGRADINT
H. Lee Moffitt Cancer Center
Ghassan El-Haddad, MD

Senior Member Interventional Radiology, Medical Director Radionuclide Therapy Program
Moffitt Cancer Center and Research Institute
Bela Kis, MD, PhD, FSIR (he/him/his)

Chief of Interventional Radiology
Moffitt Cancer Center
VG

Vaiva Gustainyte, DO

Assistant Professor of Oncologic Sciences; Assistant Member of Interventional Radiology
H. Lee Moffitt Cancer Center

Disclosure(s):

Su-Yuan Yu, BS: No financial relationships to disclose

Hakob Kocharyan, MD: No financial relationships to disclose

Bela Kis, MD, PhD, FSIR: Varian Medical Systems: Consultant (Ongoing)

Purpose: Percutaneous image guided lung biopsy is a common diagnostic procedure that entails unique risks for the patient. While imaging can be suggestive of metastatic lung disease in patients with known non-lung primary malignancy, a biopsy is frequently ordered for confirmation and further testing. The purpose of the study is to evaluate utility of lung nodule biopsy in patients with known extra-pulmonary malignancy and to determine if imaging appearance of the lung nodule has predictive value.

Materials and Methods: Retrospective analysis of 1638 percutaneous lung biopsies was performed from 8/2018 through 9/2021 in a tertiary cancer center. Patients with primary lung malignancy, no known malignancy, or biopsies performed for research were excluded. 1057 lung biopsies in 1007 patients were included in the study. Medical records and imaging were reviewed for histology, biopsy site, number, size and imaging characteristics of lung nodules, as well as technical success of the biopsies. Chi-square analysis was performed to compare variables.

Results: There were 898 (85%) patients with pre-existing non-hematologic malignancy, 100 (9.5%) patients with hematologic malignancies, and 13 (1.2%) patients with both. 91% were solid nodules, 55% of patients had multiple nodules. Median tumor size was 2.2cm (range, 0.6-18.7cm). 39% of patients were found to have a different histology on lung biopsy when compared to pre-existing diagnosis. Different histology was more commonly found in hematologic malignancies (56% vs 34.7%, p< 0.001). The diagnosis was more frequently different in patients with a single lung nodule when compared to multiple pre-existing nodules (61% vs 39%, p< 0.001). Tumor size did not have predictive value (p=0.4).

Conclusion:

While imaging characteristics can be suggestive of metastatic lung disease, it cannot be considered diagnostic as 34.7% of the patients were diagnosed with a second malignancy. Different pathology is more frequently found in hematologic malignancies and in patients with a single lung nodule at time of biopsy.