C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules: clinical experience in 1108 patients.
OBJECTIVE
To retrospectively evaluate the diagnostic performance and complications of C-arm cone-beam computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) in 1108 patients.


METHODS
This retrospective study was approved by the institutional review board with waiver of patient informed consent. From January 2009 to December 2011, 1108 patients (633 male, 475 female; mean age, 62.4 years ± 12.3 [standard deviation]) with 1116 pulmonary lesions (mean size, 2.7 cm ± 1.7) underwent 1153 cone-beam CT-guided PTNBs. A coaxial system with 18-gauge cutting needles was used. Diagnostic performance, complication rate, influencing factors, and patient radiation exposure were investigated. Variables influencing diagnostic performance and complications were assessed by using uni- and multivariate logistic regression analyses.


RESULTS
Among 1153 PTNBs, pathologic analysis showed 1148 (99.6%) were technically successful (766 malignant [66.4%], 323 benign [28.0%], and 59 [5.1%] indeterminate). Sensitivity, specificity, and accuracy for diagnosis of malignancy were 95.7% (733 of 766), 100% (323 of 323), and 97.0% (1056 of 1089), respectively. In regard to diagnostic failures (five technical failures, 33 false-negative findings), lesions 1 cm in diameter or smaller and lesions in the lower lobe were significant risk factors (P = .028 and P = .034, respectively). As for complications, pneumothorax and hemoptysis occurred in 196 (17.0%) and 80 (6.9%) procedures, respectively. Multivariate analysis revealed two or more pleural passages and emphysema along the needle pathway were the two most significant risk factors for pneumothorax, and ground-glass nodules were the most significant risk factor for hemoptysis (P < .001 for all). Virtual guidance was a significant protective factor for both pneumothorax and hemoptysis (P < .001 for both). Mean estimated effective radiation dose through cone-beam CT-guided PTNBs was 7.3 mSv ± 4.1.


CONCLUSIONS
Cone-beam CT-guided PTNB is a highly accurate and safe technique with which to diagnose pulmonary lesions with reasonable radiation exposure.
From the Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (S.M.L., C.M.P., K.H.L., Y.E.B., J.M.G.), Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (S.M.L., C.M.P., K.H.L., Y.E.B., J.M.G.); Cancer Research Institute, Seoul National University, Seoul, Korea (C.M.P., J.M.G.); and Department of Radiology, Kyung Hee University Hospital, Seoul, Korea (J.I.K.).
Sang Min
SM
Lee
Chang Min
CM
Park
Kyung Hee
KH
Lee
Young Eun
YE
Bahn
Jung Im
JI
Kim
Jin Mo
JM
Goo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods*; D002648:Child; D054893:Cone-Beam Computed Tomography; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000295:instrumentation*; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000473:pathology*