title: C-arm cone-beam computed tomography with stereotactic needle guidance for percutaneous adrenal biopsy: initial experience.
abstract: Background Metastasis to the adrenal glands is frequent in patients with various cancers and adrenal gland biopsy is routinely performed using ultrasound or computed tomographic (CT) guidance. However, this method is technically challenging, especially in the case of small masses. Purpose To determine whether the new real-time stereotactic needle guidance technique C-arm cone-beam CT (CBCT) allows safe and accurate biopsy of adrenal gland masses, especially those in hard-to-reach anatomical locations. Material and Methods CBCT guidance was used to perform 60 stereotactic biopsy procedures of lesions that were inaccessible with ultrasound or CT guidance. The needle path was carefully planned and calculated on the CBCT virtual navigation guidance system, which acquired 3D CT-like cross-sectional images. The adrenal biopsy procedures were performed with fluoroscopic feedback. Technical success rate, sensitivity, specificity, accuracy, and complications were investigated. Results The technical success rate of adrenal biopsy under CBCT virtual navigation was 100%, with a mean total procedure time of 14.6 ± 3.6 min. Of the 60 lesions, 46 were malignant, 11 were benign, and three were non-diagnostic. The three non-diagnostic lesions proved to be malignant. Thus, the sensitivity, specificity, and accuracy were 93.8%, 100%, and 95.0%, respectively. Minor bleeding occurred in two (3.3%) cases. Conclusion CBCT guidance allows safe and accurate biopsy of adrenal gland masses and may be especially useful for hard-to-reach anatomical locations.
authors.affiliation: 1 Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.
authors.forename: Dechao
authors.initials: D
authors.lastname: Jiao
authors.affiliation: 2 Department of Neurology, Anyang District Hospital of Puyang City, Henan Province, PR China.
authors.forename: Na
authors.initials: N
authors.lastname: Xie
authors.affiliation: 1 Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.
authors.forename: Gang
authors.initials: G
authors.lastname: Wu
authors.affiliation: 1 Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.
authors.forename: JianZhuang
authors.initials: J
authors.lastname: Ren
authors.affiliation: 1 Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.
authors.forename: Xinwei
authors.initials: X
authors.lastname: Han
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D000311:Adrenal Glands / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods; D054893:Cone-Beam Computed Tomography / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000295:instrumentation / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000295:instrumentation* / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: Biopsy; adrenal gland; cone-beam computed tomography (CBCT); virtual navigation