FNA-B performs better than PET-CT when imaging small pulmonary nodules

CT-guided fine-needle aspiration biopsies (FNA-Bs) have a higher sensitivity and diagnostic accuracy than PET-CT when imaging pulmonary nodules eight millimeters or smaller, according to a new study published in the Journal of Vascular and Interventional Radiology.

The authors noted that PET-CT has been proven to be superior to FNA-B for “larger primary pulmonary nodules,” but no recent research could be found that looked specifically at smaller pulmonary nodules.

“In the age of screening for patients at high risk for primary lung cancer and close oncologic surveillance for patients at risk for developing secondary lung cancers, identifying modalities that can provide a safe and effective diagnosis of subcentimeter pulmonary nodules is of paramount interest,” wrote lead author Bradley B. Pua, MD, department of radiology at Weill Cornell Medicine in New York City, and colleagues.

Pua et al. reviewed patient data from a single institution, finding 43 pulmonary nodules eight millimeters or smaller that were imaged with both FNA-B and PET-CT between January 2011 and November 2014. FNA-B was found to have a sensitivity of more than 88 percent and diagnostic accuracy of more than 81 percent. PET-CT, meanwhile, had a sensitivity of more than 38 percent and diagnostic accuracy of 46.5 percent.

“Compared with PET-CT, FNA-B had a superior sensitivity and diagnostic accuracy,” the authors wrote. “Moreover, rates of pneumothorax and subsequent chest tube placement were not increased compared with published complication rates. These findings suggest that FNA-B should play a large role in the diagnostic paradigm in high-risk patients with nodules less than or equal to eight millimeters.”