title: CT-guided core biopsy and percutaneous fiducial seed placement in the lung: can these procedures be combined without an increase in complication rate or decrease in technical success?
abstract: OBJECTIVE
  To determine if concomitant CT-guided biopsy and percutaneous fiducial seed placement in the lung can be performed in a selective patient population without increased complication or decreased success rates compared to either procedure alone.
  
  
  METHODS
  An IRB approved retrospective analysis of 285 consecutive patients that underwent CT-guided placement of fiducial seeds in the lung alone (N=63), with concomitant core biopsy (N=53) or only core biopsy (N=169) was performed. Variables compared included: patient demographics, lesion size, depth from pleura, needle size, number of passes through pleura, number and size of core biopsies, number of seeds placed and technical success rates. Statistical analysis was performed using univariate and multivariate pair-wise comparisons.
  
  
  RESULTS
  A pathologic diagnosis of malignancy was confirmed in all cases undergoing seed placement alone and seed placement with concurrent biopsy, and in 144 of the biopsy alone lesions. On univariate analysis, major complication rates were similar for all three groups as were lesion size, depth, number of pleural passes, and technical success. Pair-wise comparisons of the remaining variables demonstrated a significant younger age and smaller needle size in the biopsy only group, and less minor complications in the fiducial only group. Overall there were 80/285 (28.1%) minor and 29/285 (10.2%) major complications. All major complications leading to admission consisted of either pneumothorax or hemothorax, while minor complications included asymptomatic stable or resolving pneumothoraces, transient hemoptysis or small hemothoraces.
  
  
  CONCLUSIONS
  A combined procedure of percutaneous pulmonary core biopsy and stereotactic seed placement can be performed without additional risk of a major complication when compared to performing these separately.
authors.affiliation: Henry Ford Hospital, Department of Radiology, Abdominal Interventional Radiology, 2799 West Grand Blvd, Detroit, MI 48202, United States.
authors.forename: Mishal
authors.initials: M
authors.lastname: Mendiratta-Lala
authors.affiliation: Beth Israel Deaconess Hospital, Department of Radiology, Abdominal Imaging, One Deaconess Road, Boston, MA 02215, United States. Electronic address: rsheiman@bidmc.harvard.edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Sheiman
authors.affiliation: Beth Israel Deaconess Hospital, Department of Radiology, Abdominal Imaging, One Deaconess Road, Boston, MA 02215, United States.
authors.forename: Olga R
authors.initials: OR
authors.lastname: Brook
authors.affiliation: King's College London, St Thomas' Hospital, Lambeth Palace Road, SE1 7EH London, UK.
authors.forename: Sofia
authors.initials: S
authors.lastname: Gourtsoyianni
authors.affiliation: Beth Israel Deaconess Hospital, Radiation Oncology, One Deaconess Road, Boston, MA 02215, United States.
authors.forename: Anand
authors.initials: A
authors.lastname: Mahadevan
authors.affiliation: Beth Israel Deaconess Hospital, Department of Radiology, Abdominal Imaging, One Deaconess Road, Boston, MA 02215, United States.
authors.forename: Bettina
authors.initials: B
authors.lastname: Siewert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000295:instrumentation / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung; D005260:Female; D057918:Fiducial Markers / Q000009:adverse effects*; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects* / Q000379:methods; D008175:Lung Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology* / Q000517:prevention & control; D019919:Prosthesis Implantation / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Biopsy; Fiducial marker; Lung; Stereotactic radiotherapy