C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of small (≤ 20 mm) lung nodules: diagnostic accuracy and complications in 161 patients.
OBJECTIVE
The purpose of this study is to retrospectively evaluate the diagnostic accuracy and complications of C-arm cone-beam CT (CBCT)-guided percutaneous transthoracic needle biopsy (PTNB) for small (≤ 20 mm) lung nodules and their possible influencing factors.


METHODS
From March 2009 to July 2010, 161 consecutive patients (77 men and 84 women; mean [± SD] age, 61 ± 11.8 years; range, 29-85 years) with 173 small (≤ 20 mm) lung nodules underwent CBCT-guided PTNB performed by an experienced chest radiologist in a tertiary referral hospital. The diagnostic accuracy, sensitivity, specificity, and complication rates were statistically evaluated, and influencing factors were assessed using univariate and subsequent multivariate analysis.


RESULTS
Of 173 nodules (mean size, 15 ± 3.7 mm), 94 (54.3%) were diagnosed as malignant, 69 (39.9%) as benign, and 10 (5.8%) as indeterminate. On PTNB, 160 nodules were correctly diagnosed and three were false-negatives. Diagnostic accuracy, sensitivity, and specificity were 98.2%, 96.8%, and 100%, respectively. No factors significantly decreased diagnostic accuracy. As for complications, pneumothorax, hemoptysis, and chest pain occurred in 55 (31.8%), 25 (14.5%), and two (1.2%) patients, respectively. Multivariate analysis revealed that the presence of emphysema along the needle pathway was a significant risk factor (odds ratio [OR], 10.11), and the occurrence of hemoptysis was a significant protective factor (OR, 0.28) against pneumothorax. Ground-glass nodules were found to be a significant independent risk factor for hemoptysis (OR, 5.10).


CONCLUSIONS
C-arm CBCT-guided PTNB is highly accurate for small lung nodules, and the diagnostic accuracy does not significantly decrease even in technically challenging conditions.
Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
Jin Woo
JW
Choi
Chang Min
CM
Park
Jin Mo
JM
Goo
Yang-Kyun
YK
Park
Wonmo
W
Sung
Hyun-Ju
HJ
Lee
Sang Min
SM
Lee
Ji Young
JY
Ko
Mi-Suk
MS
Shim
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000009:adverse effects / Q000379:methods; D054893:Cone-Beam Computed Tomography; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008171:Lung Diseases / Q000175:diagnosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000473:pathology*