What question did this study set out to answer?

This study aims to assess whether changes in Hounsfield units during biopsy can predict malignancy in thoracic lesions.

June 1, 2026British Journal of Hospital Medicine0 citationsOpen Access

Hounsfield Unit Dynamics During CT-Guided Transthoracic Core Needle Biopsy as a Predictor of Malignant vs. Non-Malignant Thoracic Lesions

Q: What does this research mean for the field?

The post-biopsy change in Hounsfield units (ΔHU) during CT-guided transthoracic core needle biopsy can accurately differentiate malignant from necrotic or inflammatory thoracic lesions. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.ESTABLISHES_NEW_DIRECTION.

MYMustafa YeşilyurtAtatürk University BKBuğra KergetAksaray University ÖKÖzlem KücükogluAtatürk University

Key Points

This study aims to assess whether changes in Hounsfield units during biopsy can predict malignancy in thoracic lesions.
Retrospective analysis of 166 patients undergoing CT-guided transthoracic core needle biopsy from June 2023 to November 2025.
Non-contrast CT images analyzed for Hounsfield unit measurements before and after biopsy, focusing on biopsy tract.
Receiver operating characteristic analysis used to evaluate diagnostic performance of post-biopsy ΔHU values.
Malignant lesions showed significantly higher pre- and post-biopsy Hounsfield unit values compared to necrotic and inflammatory lesions (p < 0.001).
ΔHU values indicated a positive change in malignant lesions, a negative change in necrotic lesions, and minimal change in inflammatory lesions (p < 0.001).
ΔHU demonstrated excellent diagnostic ability for malignancy with an AUC of 0.956, sensitivity of 94%, and specificity of 78%.

Abstract

Aims/Background: Hounsfield unit (HU) measurements on computed tomography (CT) offer quantitative information on tissue composition, yet their dynamic changes during CT-guided transthoracic core needle biopsy (TCNB) have not been previously investigated. This study aimed to determine whether the post-biopsy change in HU (ΔHU) at the needle tract can predict histopathological outcomes in thoracic lesions, serving as a surrogate marker of tissue viability and vascularity. Methods: This study retrospectively included 166 patients who underwent CT-guided TCNB between June 2023 and November 2025. Non-contrast CT images (2-mm slices) obtained immediately before and after biopsy were analyzed. Regions of interest were placed along the biopsy tract, avoiding air and necrotic components. ΔHU was calculated by subtracting pre-biopsy from post-biopsy HU values. Two radiologists independently measured HU, with excellent interobserver agreement (α = 0.849). ΔHU values were compared across histopathological groups (malignant, necrotic, inflammatory), and diagnostic performance was assessed using receiver operating characteristic (ROC) analysis. Results: Malignant lesions demonstrated higher attenuation values pre-biopsy (median 32 interquartile range (IQR) 25–40 HU) and post-biopsy (41 35–49.25 HU) compared with necrotic (31.5 24.5–35 HU and 25 20–30 HU) and inflammatory lesions (27 12–35 HU and 25 12–37 HU), respectively (p < 0.001). ΔHU was positive in malignant lesions (10 7–13 HU), negative in necrotic lesions (–3.5 –6 to –1.25 HU), and minimal in inflammatory lesions (1 –2 to 2 HU) (p < 0.001). ΔHU showed excellent discriminatory ability for malignancy (area under the curve AUC = 0.956), with a sensitivity of 94% and a specificity of 78%. Conclusion: ΔHU measurement during TCNB may serve as a quantitative biomarker with potential to differentiate malignant from necrotic or inflammatory thoracic lesions. Incorporating ΔHU may provide additional information that could enhance diagnostic confidence and guide biopsy targeting, although prospective studies are needed to confirm its impact on clinical decision-making.

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