Concordance between radiologic and pathologic findings of patients with image guided transthoracic biopsy or fine needle aspiration done among patients who visited interventional radiology unit at SPHMMC

Abstract

Abstract Background- Thoracic lesions include variety of benign and malignant conditions of the lung, pleura, mediastinum and vertebra. Diagnosis of these lesions requires clinical data, laboratory investigations and radiologic imagings including x-ray, ultrasound, chest CT, MRI and PET Scan. If required, the next step is pathologic diagnosis; image guided percutaneous biopsy being one of the common minimally invasive modern procedures for obtaining tissue samples. This study examines the concordance between radiologic reports and histopathologic findings and evaluates the contribution of image-guided sampling to our clinical practice. Objectives: To assess the concordance between radiologic and pathologic findings of patients with image guided transthoracic biopsy/FNAC done at SPHMMC interventional radiology (IR) unit from November 2019 -April 2024. Methods: A retrospective chart review was conducted from May to June 2024 at Saint Paul’s Hospital Millennium Medical College (SPHMMC) in Addis Ababa. All patients who had image guided transthoracic biopsies after detection of a mass/nodule on chest CT during the study period were included. Data were collected by the principal investigator and a trained radiology resident. Radiologic reports were categorized by three readers as benign, malignant (not otherwise specified); primary lung (pleural, mediastinal) malignancy or metastatic lesion. Inter-reader radiologic and radiopathologic concordance was assessed using kappa statistics (Fleiss’ and Cohen’s Kappa). Result and conclusion: The radiopathologic agreement among patients undergoing image guided transthoracic biopsy/FNAC at our hospital's IR unit was borderline moderate (Cohen's kappa value of 0.406). We observed an 80.2% concordance rate, with notable discordance seen in pleural metastatic adenocarcinomas and common inflammatory lesions like TB. Our study found that image-guided transthoracic CNB/FNAC is safe and effective with diagnostic yield of 86.3%, and procedural complication of minimal pneumothorax in 6.9% of cases. Lesions smaller than 2cm, and post-procedural pneumothorax were significant factors affecting diagnostic yield. Keywords- Transthoracic, Biopsy, Image guided, concordance, Radiologic, Pathologic, Lung cancer, Saint Paul’s Hospital Millennium Medical College, Interventional radiology, Retrospective Chart Review