title: CT fluoroscopy guided transpleural cutting needle biopsy of small (≤2.5 cm) subpleural pulmonary nodules.
abstract: OBJECTIVE
  Small subpleural pulmonary lesions are difficult to biopsy. While the direct, short needle path has been reported to have a lower rate of pneumothorax, the indirect path provides a higher diagnostic yield. Therefore, we tried to optimize the needle pathway and minimize the iatrogenic pneumothorax risk by evaluating a CT fluoroscopy guided direct approach to biopsy subpleural lesions.
  
  
  METHODS
  Between 01/2005 and 01/2007, CT fluoroscopy guided core biopsies were performed in 24 patients. Using our technique, the tip of the guide needle remains outside the visceral pleura (17 G coaxial guide needle, 18 G Biopsy-gun, 15 or 22 mm needle path). The position of the lesion relative to the needle tip can be optimized using CT fluoroscopy by adjusting the breathing position of the patient. The Biopty gun is fired with the needle tip still outside the pleural space. Cytological smears are analyzed by a cytopathologist on-site, and biopsies are repeated as indicated with the coaxial needle still outside the pleura.
  
  
  RESULTS
  Median nodule size was 1.6 cm (0.7-2.3 cm). A definitive diagnosis was obtained in 22 patients by histology and/or cytology. In one patient, only necrotic material could be obtained. In another patient, the intervention had to be aborted as the dyspnoic patient could not follow breathing instructions. An asymptomatic pneumothorax was present in seven patients; chest tube placement was not required.
  
  
  CONCLUSIONS
  The presented biopsy approach has a high diagnostic yield and is especially advantageous for biopsies of small subpleural lesions in the lower lobes.
authors.affiliation: Otto Wagner Hospital, Department of Radiology, Vienna, Austria.
authors.forename: Helmut
authors.initials: H
authors.lastname: Prosch
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Oschatz
authors.forename: Edith
authors.initials: E
authors.lastname: Eisenhuber
authors.forename: Helmut
authors.initials: H
authors.lastname: Wohlschlager
authors.forename: Gerhard H
authors.initials: GH
authors.lastname: Mostbeck
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging* / Q000473:pathology*; D010994:Pleura / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*