title: Comparison of cone-beam CT-guided and CT fluoroscopy-guided transthoracic needle biopsy of lung nodules.
abstract: OBJECTIVE
  To compare the diagnostic performance of cone-beam CT (CBCT)-guided and CT fluoroscopy (fluoro-CT)-guided technique for transthoracic needle biopsy (TNB) of lung nodules.
  
  
  METHODS
  The hospital records of 319 consecutive patients undergoing 324 TNBs of lung nodules in a single radiology unit in 2009-2013 were retrospectively evaluated. The newly introduced CBCT technology was used to biopsy 123 nodules; 201 nodules were biopsied by conventional fluoro-CT-guided technique. We assessed the performance of the two biopsy systems for diagnosis of malignancy and the radiation exposure.
  
  
  RESULTS
  Nodules biopsied by CBCT-guided and by fluoro-CT-guided technique had similar characteristics: size, 20 ± 6.5 mm (mean ± standard deviation) vs. 20 ± 6.8 mm (p = 0.845); depth from pleura, 15 ± 15 mm vs. 15 ± 16 mm (p = 0.595); malignant, 60% vs. 66% (p = 0.378). After a learning period, the newly introduced CBCT-guided biopsy system and the conventional fluoro-CT-guided system showed similar sensitivity (95% and 92%), specificity (100% and 100%), accuracy for diagnosis of malignancy (96% and 94%), and delivered non-significantly different median effective doses [11.1 mSv (95 % CI 8.9-16.0) vs. 14.5 mSv (95% CI 9.5-18.1); p = 0.330].
  
  
  CONCLUSIONS
  The CBCT-guided and fluoro-CT-guided systems for lung nodule biopsy are similar in terms of diagnostic performance and effective dose, and may be alternatively used to optimize the available technological resources.
  
  
  CONCLUSIONS
  • CBCT-guided and fluoro-CT-guided lung nodule biopsy provided high and similar diagnostic accuracy. • Effective dose from CBCT-guided and fluoro-CT-guided lung nodule biopsy was similar. • To optimize resources, CBCT-guided lung nodule biopsy may be an alternative to fluoro-CT-guided.
authors.affiliation: Center for Thoracic Surgery, Insubria University, Viale Borri 57, 21100, Varese, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Rotolo
authors.affiliation: Radiology Department, Insubria University, Viale Borri 57, 21100, Varese, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Floridi
authors.affiliation: Center for Thoracic Surgery, Insubria University, Viale Borri 57, 21100, Varese, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Imperatori
authors.affiliation: Radiology Department, Insubria University, Viale Borri 57, 21100, Varese, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Fontana
authors.affiliation: Radiology Department, Insubria University, Viale Borri 57, 21100, Varese, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Ierardi
authors.affiliation: Radiology Department, Insubria University, Viale Borri 57, 21100, Varese, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Mangini
authors.affiliation: Center for Thoracic Surgery, Insubria University, Viale Borri 57, 21100, Varese, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Arlant
authors.affiliation: Radiology Department, Insubria University, Viale Borri 57, 21100, Varese, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Marchi
authors.affiliation: Medical Physics Department, Insubria University, Viale Borri 57, 21100, Varese, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Novario
authors.affiliation: Center for Thoracic Surgery, Insubria University, Viale Borri 57, 21100, Varese, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Dominioni
authors.affiliation: Radiology Department, Insubria University, Viale Borri 57, 21100, Varese, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Fugazzola
authors.affiliation: Radiology Department, Insubria University, Viale Borri 57, 21100, Varese, Italy. gcarraf@gmail.com.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Carrafiello
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D054893:Cone-Beam Computed Tomography / Q000379:methods; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: C-arm cone-beam CT; CT fluoroscopy; Lung nodule biopsy; Radiation dose; Transthoracic needle biopsy