Ablation-first versus biopsy-first strategy in computed tomography (CT)-guided biopsy-cryoablation for pulmonary nodules: a retrospective cohort study.

AIM: The aim of this study was to investigate the safety and diagnostic performance of ablation-first versus biopsy-first approach for computed tomography (CT)-guided biopsy-cryoablation of pulmonary nodules.

MATERIALS AND

METHODS

This retrospective analysis included 60 patients (60 pulmonary nodules) undergoing CT-guided biopsy-cryoablation between February 2023 and October 2023 at authors' centre: 28 in the ablation-first cohort and 32 in the biopsy-first cohort. The two groups were compared in technical success rate, positive biopsy rate, 1-year disease-free survival (DFS) rate, and procedure-related complications. Multivariate logistic regression was conducted to identify variables associated with haemorrhage; results are shown as odds ratio (OR) and 95% confidence interval (CI).

RESULTS

The mean size of pulmonary nodules was 1.6 ± 0.5 cm. The technical success rate was 100%, the median follow-up time was 13 months, and the 1-year DFS rate was 100%. The positive biopsy rate was 78.1% (25/32) in the biopsy-first cohort and 85.7% (24/28) in the ablation-first cohort (P=0.423). The ablation-first cohort had a lower rate of total procedure-related complications (53.6% vs 78.1% in the biopsy-first cohort, P=0.04) as well as a lower rate of intraoperative bleeding (10.7% vs 40.6%, P=0.03). In the multivariable regression analysis, intraoperative haemorrhage was independently associated with perivascular nodule location (OR: 4.20, 95% CI: 1.55-11.40, P=0.005) and the biopsy-first approach (OR: 3.70, 95% CI: 1.25-11.10, P=0.018).

CONCLUSION

In comparison to biopsy-first approach, ablation-first approach was associated with comparable positive biopsy rate but lower haemorrhage risk in patients undergoing CT-guided biopsy-cryoablation of pulmonary nodules.