3D cone-beam CT guidance, a novel technique in renal biopsy--results in 41 patients with suspected renal masses.
OBJECTIVE
To determine whether 3D cone-beam computed tomography (CBCT) guidance allows safe and accurate biopsy of suspected small renal masses (SRM), especially in hard-to-reach anatomical locations.


METHODS
CBCT guidance was used to perform 41 stereotactic biopsy procedures of lesions that were inaccessible for ultrasound guidance or CT guidance. In CBCT guidance, a 3D-volume data set is acquired by rotating a C-arm flat-panel detector angiosystem around the patient. In the data set, a needle trajectory is determined and, after co-registration, a fusion image is created from fluoroscopy and a slice from the data set, enabling the needle to be positioned in real time.


RESULTS
Of the 41 lesions, 22 were malignant, 17 were benign, and 2 were nondiagnostic. The two nondiagnostic lesions proved to be renal cell carcinoma. There was no growth during follow-up imaging of the benign lesions (mean 29 months). This resulted in a sensitivity, specificity, PPV, NPV, and accuracy of 91.7, 100, 100, 89.5, and 95.1%, respectively. Mean dose-area product value was 44.0 Gy·cm(2) (range 16.5-126.5). There was one minor bleeding complication.


CONCLUSIONS
With CBCT guidance, safe and accurate biopsy of a suspected SRM is feasible, especially in hard-to-reach locations of the kidney.


CONCLUSIONS
• Cone-beam computed tomography has potential advantages over conventional CT for interventional procedures.                                  • CBCT guidance incorporates 3D CBCT data, fluoroscopy, and guidance software.                 • In hard-to-reach renal masses, CBCT guidance offers an alternative biopsy method.                                  • CBCT guidance offers good outcome and safety and has potential clinical significance.
Department of Radiology, St Antonius Hospital, PO Box 2500, 3430 EM, Nieuwegein, The Netherlands. sjbraak@gmail.com
Sicco J
SJ
Braak
Harm H E
HH
van Melick
Mircea G
MG
Onaca
Johannes P M
JP
van Heesewijk
Marco J L
MJ
van Strijen
D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007668:Kidney / Q000000981:diagnostic imaging* / Q000473:pathology*; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*