315 - One-Stop Diagnosis and Treatment: CT Biopsy with Immediate Cryoablation in Medically Inoperable Patients with Suspicious Lung Nodules

Purpose: To evaluate the safety and technical success of a single-session approach, CT-guided biopsy immediately followed by cryoablation, for highly suspicious 1–2 cm solitary pulmonary nodules in medically inoperable patients.

Materials and Methods: From July 2020 through July 2023, 45 patients with a single, highly suspicious malignant pulmonary nodule underwent combined biopsy and cryoablation. Inclusion criteria: severe emphysema (FEV 30–49%), at least moderate FDG uptake (SUV > 5), nodule size 1–2 cm, and medically inoperable status. We retrospectively assessed technical success, procedural complications, diagnostic yield, and local control.

Results: The diagnostic yield of the biopsy specimen was 93.3%, (42/45). In the diagnostic yield, 95.2% of the pathology specimen were consistent with malignancy (60% lung adenocarcimoma, 40% squamous cell cartinemal, 4:5% reported atypical cells. Technical success were achieved in 100% of the cases. The most common complications included pneumothorax 17.8%, intrapulmonary hemorrhage 13.3%, hemoptyis 6.6% and pleural effusion 4.4. The 2 year local control was 87.5% for this cohort.

Conclusion: A combined diagnostic-therapeutic strategy: CT-guided biopsy immediately followed by cryoablation of a highly suspicious solitary pulmonary lesion, selected by emphysema severity and PET FDG avidity, appears safe and effective, yielding a high pathologic positive rate and good overall local tumor control.