Clinical application of microwave ablation combined with coaxial needle biopsy using different sequences for treating lung nodules suggestive of malignancy.

Abstract

Objective: This study aimed to evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous microwave ablation (MWA) combined with coaxial needle biopsy performed in different sequences for treating lung nodules with signs of malignancy.

Methods: A retrospective analysis was conducted on 51 patients (56 lesions) with lung nodules treated with MWA and coaxial needle biopsy between January 2020 and March 2024. Patients were divided into Group A (post-MWA biopsy; 26 patients, 29 lesions) and Group B (pre-MWA biopsy; 25 patients, 27 lesions). Ablation parameters, postoperative complications, prognosis, and pathological diagnosis rates were compared between groups. Patients with malignant pathology findings from both groups (Group C) were analyzed for overall survival (OS) and progression-free survival (PFS).

Results: Technical success for needle biopsy and MWA was 100%. Pneumothorax incidence was 24.14% (7/29) in Group A and 33.33% (9/27) in Group B (p = 0.447). Intrapulmonary hemorrhage occurred in 13.79% (4/29) of Group A patients and 37.04% (10/27) of Group B of patients, showing a significantly higher rate in Group B (p = 0.026). The pathological diagnosis rate was 100% in both the groups, with malignancy rates of 72.41% (21/29) in Group A and 81.48% (22/27) in Group B (p = 0.422). For Group C, the 1-3-year OS rates were 100.00%, 93.75%, and 75.00%, respectively, and the corresponding PFS rates were 97.50%, 84.38%, and 60.00%.

Conclusions: Biopsy post-MWA maintains pathological diagnostic accuracy while significantly reducing the incidence of intrapulmonary hemorrhage compared to pre-MWA biopsy.