Initial experience of percutaneous transthoracic needle biopsy of lung nodules using C-arm cone-beam CT systems

Abstract

To describe our initial experience with percutaneous transthoracic biopsy (PCNB) of lung nodules using C-arm cone-beam CT (CBCT). Seventy-one consecutive patients with lung nodules of 30 mm or smaller underwent CBCT-guided PCNB using a coaxial cutting needle. We evaluated the procedure time, coaxial introducer dwell time, the numbers of pleural passages, coaxial introducer repositionings and CT acquisitions, as well as the technical success rate and radiation doses. Diagnostic accuracy, sensitivity, specificity and incidence of complications were also evaluated. PCNB was performed for 71 nodules: 63 solid, 6 part-solid and 2 ground-glass nodules. The procedure time, coaxial introducer dwell time, numbers of pleural passages, coaxial introducer repositionings and CT acquisitions were 17.9 +/- 5.9 min, 8.7 +/- 3.8 min, 1.1 +/- 0.4, 0.2 +/- 0.5 and 2.9 +/- 0.7, respectively. The technical success rate was 100% and the radiation dose was 272 +/- 116 mGy. Thirty-six nodules (50.7%) were diagnosed as malignant, 25 (35.2%) as benign and 10 (14.1%) as indeterminate. Diagnostic accuracy, sensitivity, specificity and incidence of complications were 98.4%, 97%, 100% and 38%, respectively. Complications included pneumothorax in 18 patients (25.4%), haemoptysis in 10 (14.1%) and chest pain in one (1.4%). Under CBCT guidance, PCNB of lung nodules can be performed accurately, providing both real-time fluoroscopic guidance and CT imaging capabilities.