CT-guided fine-needle ago-biopsy of pulmonary nodules: predictive factors for diagnosis and pneumothorax occurrence

Objective: To evaluate variables that could predict diagnosis during CT-guided fine-needle aspiration. Methods: Data from 249 patients who underwent FNAB from January 2010 to December 2012 were analyzed in a retrospective observational study. Results: Mean age was 66.7 ± 11.5 years, male/female ratio 158/91 (63 vs. 37 %). The nodules were in right lung in 123 patients (49 %), in left lung in 126 patients (51 %), the upper, lower and middle lobe localizations were, respectively in 122 (49 %), 100 (40 %) and 17 (6 %) patients. Mean nodule-chest wall distance was 63.89 ± 21.38 mm. The tumor location, the needle diameter, the presence of necrosis or cavitation, the node-chest wall distance and the number of passages were not related to the diagnostic outcome (p = NS). The nodule diameter was predictive of diagnosis. Odds ratio for a 10-30 mm tumor was 2.51 (95 % OR: 1.24–5.08, p value = 0.011), the odds ratio for a 30–50 mm tumor was 2.39 (95 % OR: 1.22–4.69, p value = 0.011), and the odds ratio for a tumor larger than 50 mm was 4.44 (95 % OR: 1.89–10.44, p value = 0.001). Post-procedure pneumothorax occurred in 62 cases (25 %). The determinant factors for pneumothorax occurrence were emphysema, odds ratio 6.87 (95 % CI 1.07–44.10, p value = 0.04), and the number of pleural passages, odds ratio of 5.47 (95 % OR: 1.92–15.58), 7.44 (95 % OR: 2.58–21.5), 6.13 (95 % OR: 2.07–18.11) p value = 0.001 for one, two, three or more of three passages, respectively. Conclusions: In our experience, nodule size is the most important diagnostic factor during fine-needle aspiration, while the number of passages and the presence of emphysema constitute risk factors for pneumothorax occurrence.