title: Feasibility of CT-guided large-bore biopsy of lung tumors with the use of an outer sheath.
abstract: OBJECTIVE
  To evaluate the feasibility, volume of biopsy specimens, and procedure-related tumor seeding of computed tomography (CT)-guided large-bore lung tumor biopsy through an outer sheath in advanced lung cancer.
  
  
  METHODS
  Eighteen procedures were performed in 18 patients with established diagnosis of advanced or recurrent lung cancer. Biopsy specimens were obtained under local anesthesia and with fluoroscopic CT guidance. First, an outer sheath was placed in the tumor. Next, a semiautomatic cutting biopsy needle (14-gauge, n = 6; 12-gauge, n = 12) was inserted through the outer sheath, and the tumor biopsy specimen was obtained. After biopsy, the outer sheath was left in place for approximately 10 minutes, during which time hemostasis was achieved. The primary goal was feasibility. Secondary goals were volume of biopsy specimens and incidence of procedure-related tumor implantation.
  
  
  RESULTS
  Bleeding volume during the procedure ranged from 0-50 g (median, 5 g; mean, 9 g) and stopped within 10 minutes in all patients. Pneumothorax occurred in two patients (11 %) and improved without chest tube insertion. Specimens could be obtained for the full needle length (2 cm) in 17 patients (94%), which enabled the chemosensitivity test to be performed in 14 patients (78%). Procedure-related tumor seeding was not apparent in any patient at a median of 16 months of follow-up after the procedure.
  
  
  CONCLUSIONS
  The present study showed that lung tumor biopsy with a 12-gauge needle through an outer sheath was feasible and enabled acquisition of specimens adequate for chemosensitivity testing without apparent procedure-related tumor seeding.
authors.affiliation: Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. yotaroizumi@a2.keio.jp
authors.forename: Yotaro
authors.initials: Y
authors.lastname: Izumi
authors.forename: Seishi
authors.initials: S
authors.lastname: Nakatsuka
authors.forename: Keisuke
authors.initials: K
authors.lastname: Asakura
authors.forename: Kenzo
authors.initials: K
authors.lastname: Soejima
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nomori
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D057785:Catheters / Q000009:adverse effects; D004354:Drug Screening Assays, Antitumor; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D007564:Japan; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D011030:Pneumothorax / Q000209:etiology; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000295:instrumentation*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome