Does Repeating CT-Guided Transthoracic Fine Needle Aspiration Increase Diagnostic Yield and Complication Rate? A Single Institution Experience

Background: transthoracic fine needle aspiration biopsy is a well-established and safe technique for obtaining pulmonary tissue. however, there is very little data about repeating procedure. objectives: we aimed to investigate whether repeating ct-guided transthoracic fine needle aspiration (tfna) increases diagnostic yield and complication rate. patients and methods: patients underwent tfna and the final diagnoses achieved were included in the study. consequently, 316 tfna procedures performed in 240 patients were investigated retrospectively. a diagnosis was not reached in the first tfna in 64 patients, then they underwent repeated tfna. the factors that affected the diagnostic yield and complication rate were recorded. results: the final diagnoses of 199 (82.9%) patients were malignant and 41 patients were benign. one hundred seventy six patients underwent the tfna procedure only once. sixty-four patients underwent a second procedure, while 12 underwent a third one. the diagnosis rate in the first procedures (diagnosis obtained in 142 out of 240 patients) was 59%. with the repeated procedures, 30 other patients were diagnosed. the diagnosis rate increased to 72% (172 out of 240 patients) (p<0.001). twenty-nine (9.2%) pneumothoraces in 26 patients were detected in 316 tfna procedures. in the repeated tfna group (64 patients) there were seven pneumothoraces (11%) in the first tfna procedure and six pneumothoraces (9%) in the repeated tfna procedures (p=0.41). in three patients, pneumothorax was detected in the first and repeated procedures. pneumothorax was significantly associated with the maximum diameter of the lesion (p=0.003), distance to pleura (p=0.001), contact to the pleura (p=0.0001) and smoking history (pack/year) (p=0.04). conclusion: this study demonstrated that repeating the tfna procedure in pulmonary lesions improves the diagnostic yield without an increase in the rate of pneumothorax.