Abstract Objectives To assess the safety and diagnostic performance of CT-guided core needle biopsy (CNB) of focal pulmonary lesions with coexisting interstitial lung abnormalities (ILAs). Materials and methods This retrospective 1:1 matched case–control study included patients with ILAs and controls who underwent CT-guided CNB of a focal pulmonary lesion from February 2010 to December 2023. Complications, nondiagnostic specimens, and CNB diagnostic performance for malignancy were compared. Logistic regression was used to identify predictors of complications and nondiagnostic specimens. Resected cases were reviewed for histopathological changes in the nonneoplastic lung. Results Seventy-three patients with ILAs and matched controls were included (both groups: median age, 73.0 years; 13 women). No significant difference was found in complications (overall: 21/73 29% vs 24/73 33%, p = 0.72; major: 2/73 3% vs 3/73 4%, p = 1.00; minor: 19/73 26% vs 21/73 29%, p = 0.85), nondiagnostic specimens (12/73 16% vs 9/73 12%, p = 0.20), or diagnostic performance (accuracy: 89% 65/73 vs 96% 70/73, p = 0.11; sensitivity: 88% 61/69 vs 95% 62/65, p = 0.13; specificity: 100% 4/4 vs 100% 8/8, p = 1.00). Needle traversal of ILAs (OR, 7.04; 95% CI: 2.07–26.28; p = 0.008) and multiple pleural passes (OR, 8.06; 95% CI: 1.26–70.46; p = 0.03) were associated with complications. Nonneoplastic lung in ILAs revealed more complex histology and increased fibrotic features than controls. Conclusion CT-guided CNB of focal pulmonary lesions with coexisting ILAs was as safe and accurate as in patients without ILAs. However, traversing ILAs and multiple pleural passes increased complication risk. Key Points Question Whether CT-guided CNB of focal pulmonary lesions with coexisting ILAs is as safe and accurate as in those without ILAs . Findings CNB in patients with ILAs showed similar safety and diagnostic performance to controls; however, complications were more frequent when ILAs were traversed or multiple pleural passes were performed . Clinical relevance CNB is a safe and effective diagnostic tool in patients with ILAs. Avoiding ILA traversal and multiple pleural passes may help minimize the risk of complications . Graphical Abstract
Balbi et al. (Fri,) studied this question.