European Journal of Radiology 81 (2012) 354–359 Contents lists available at ScienceDirect European Journal of Radiology journal homepage: www.elsevier.com/locate/ejrad CT fluoroscopy-guided cutting needle biopsy of focal pure ground-glass opacity lung lesions: Diagnostic yield in 83 lesions Daisaku Inoue a,∗ , Hideo Gobara a , Takao Hiraki a , Hidefumi Mimura a , Katsuya Kato a , Kentaro Shibamoto a , Tatsuhiko Iishi a , Yusuke Matsui a , Shinichi Toyooka b , Susumu Kanazawa a a Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Okayama 700-8558, Japan b Department of Cancer and Thoracic Surgery, Okayama University Medical School, 2-5-1 Shikatacho, Okayama 700-8558, Japan article info Article history: Received 1 August 2010 Received in revised form 31 October 2010 Accepted 12 November 2010 Keywords: CT Lung biopsy Pulmonary neoplasms Ground-glass opacity lesion Diagnostic yield abstract Objective: The objective of our study was to retrospectively determine the diagnostic yield of CT fluoroscopy-guided cutting needle biopsy of focal pure ground-glass opacity lung lesions. Materials and methods: Biopsies were performed using 20-G coaxial cutting needles for 83 focal pure ground-glass opacity lung lesions (mean lesion size, 12.1 mm). After excluding the lesions for which biopsy specimens were unobtainable and final diagnoses were undetermined, the diagnostic yield, includ- ing sensitivity and specificity for a diagnosis of malignancy and accuracy, was calculated. The lesions were then divided into 2 groups: the diagnostic failure group, comprising lesions with false-negative results and for which a biopsy specimen was unobtainable; and the diagnostic success group, comprising lesions with true-negative results and true-positive results. Various variables were compared between the 2 groups by univariate analysis. Results: Biopsy specimens were obtained from 82 lesions, while specimens could not be obtained from 1 lesion. Final diagnosis was undetermined in 16 lesions. The sensitivity and specificity for a diagnosis of malignancy were 95% (58/61) and 100% (5/5), respectively. Diagnostic accuracy was 95% (63/66). The 4 lesions in diagnostic failure group were smaller, deeper, and more likely to be located in the lower lobe and further, for those lesions, number of specimens obtained was smaller, compared with 63 lesions in diagnostic success group. However, none of the differences were statistically significant. Conclusion: CT fluoroscopy-guided cutting needle biopsy provided high diagnostic yield for focal pure ground-glass opacity lung lesions. © 2010 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Approximately 75% of focal pure ground-glass opacity (GGO) lesions are bronchioloalveolar adenocarcinoma (BAC) or adeno- carcinoma with a predominant BAC component [1]. In addition, focal GGO lesions include premalignant lesions such as atypi- cal adenomatous hyperplasia (AAH) and benign conditions such as inflammation and fibrosis [2,3]. Studies have suggested that the findings of a diameter larger than 10 mm, nodular spheric- ity, and internal air bronchogram may be more likely to indicate a malignant lesion [4]. Nevertheless, determination of the lesions as ∗ Corresponding author. Tel.: +81 86 235 7313; fax: +81 86 235 7316. E-mail addresses: ebized@uoen.com (D. Inoue), gobara@cc.okayama-u.ac.jp (H. Gobara), takaoh@tc4.so-net.ne.jp (T. Hiraki), hmimura@cc.okayama-u.ac.jp (H. Mimura), kato-rad@cc.okayama-u.ac.jp (K. Kato), spab4xq9@yahoo.co.jp (K. Shibamoto), taiishi@cc.okayama-u.ac.jp (T. Iishi), wckyh140@yahoo.co.jp (Y. Matsui), toyooka@md.okayama-u.ac.jp (S. Toyooka), susumu@cc.okayama-u.ac.jp (S. Kanazawa). malignancy, premalignancy, or benignity using CT characteristics alone is often difficult. CT-guided biopsy is an established diagnostic technique that has high diagnostic yield and is used mainly for solid lung lesions [5–7]. Although this technique may be also applied to GGO lesions [8–10], the usefulness of this technique for pure GGO lesions is poorly understood. Thus, the purpose of this study was to retro- spectively determine the diagnostic yield of CT fluoroscopy-guided needle biopsy for focal pure GGO lesions. 2. Materials and methods We performed the CT fluoroscopy-guided lung biopsies after obtaining informed consent from the patients. The review board of our institution did not require its approval for us to perform this retrospective study. Although we already reported the over- all diagnostic yield of this procedure that was performed between April 2000 and August 2008 [5], in this study we focused on using this procedure for pure GGO lesions. 0720-048X/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrad.2010.11.025