Correlation of X-ray and Pathology With Needle Biopsy of Lung Tumors

Pilot Study of Radiologic-Pathologic Correlation in Lung Tumors Based on Core Needle Biopsy

The purpose of this study is to compare the features that the pathologist sees, when examining a lung tumor under the microscope, to the way that the tumor appears on the computed tomography (CT) scan. Features of the tumor may include abnormal blood vessels and areas in which tumor cells are dying. The samples that are taken during the needle biopsy contain information from one small part of the tumor. The investigators believe that they can show where in the tumor the samples came from, based on the CT scans during the biopsy procedure. If the investigators can accurately determine where in the tumor their samples came from, they can compare the features of that part of the tumor, as seen on the CT images, to the features of that part of the tumor as seen under the microscope. This research study also will give the investigators an idea of how much the biopsy samples are distorted in the process of preparing them for examination under the microscope.

Newer cross-sectional imaging methods allow improved visualization of anatomic detail-for example, high-resolution CT has a spatial resolution of less than 1 mm in all 3 dimensions. These imaging methods also provide a limited amount of physiologic information-for example, tumor perfusion as demonstrated by enhancement with intravenous contrast agents. Radiologic-pathologic correlation in the current era gives us the opportunity to work on a finer spatial scale and to take advantage of the additional physiologic information. Pathologic assessment of tissue has evolved at the same time. Tissue can be stained in the traditional way for microscopic evaluation but newer tools such as immunohistochemistry and, most recently, methods of molecular biology can be applied as well.

We are interested in radiologic-pathologic correlation in lung tumors. Tumors are known to be heterogeneous; we want to develop an approach that will allow us to explore their spatial organization. We cannot rely on surgical resection to provide tissue for pathologic evaluation, because the majority of lung lesions never come to resection. For example, only ~15% of lung cancer patients are surgical candidates. The remainder would be lost to the classical approach that depends on surgery. Percutaneous needle biopsy provides an alternative means of tissue sampling. This is a safe, effective and commonly used way to obtain samples of tissue ("core samples") from any given lung mass. The pathologist can process these core samples in the same way as a surgical specimen.

Inclusion Criteria:

• Subjects who have a lung tumor that is likely to be malignant
• Subjects who have been referred for percutaneous needle biopsy
• The target lesion must be at least 10 mm in short-axis dimension.
• Subjects must have intravenous access.
• No history of significant allergy to intravenous contrast.
• Subjects must have sufficient renal function to receive intravenous contrast for enhancement of the CT images.

Exclusion Criteria:

• Vulnerable populations will be excluded.
• Subjects who lack the capacity to provide consent
• Subjects who are pregnant