title: Extra-pleuric coaxial system for CT-guided percutaneous fine-needle aspiration biopsy (FNAB) of small (≤20 mm) lung nodules: a novel technique using multiplanar reconstruction (MPR) images.
abstract: The aim of the study is to present the diagnostic feasibility, usefulness, and safety of a novel technique for coaxial CT-guided fine-needle aspiration biopsy of small (≤20 mm in diameter) lung nodules. A 18-gauge (G) (1.2 × 40 mm) needle is inserted through the skin in the depth of the thoracic wall tissues remaining outside the pleura. Its positioning is planned and adjusted using multiplanar reconstruction (MPR) images along the 18-G guide needle axis tracing a reference outline extended from the needle tip to the target nodule. When the insertion of the 18-G extra-pleuric needle (EPN) proves to be precise, a 22-G Chiba needle is then passed through the outer 18-G EPN until it reaches the thoracic lesion for the sampling procedure. Patient population included 153 males and 94 females, with a mean age of 61.3 ± 21.6 years. Mean nodule diameter was 14.1 ± 2.2 mm. The lesion depth from pleural plane ranged from 0 mm to 127 mm. An average of 1.29 aspirates were performed per lesion. The most common complication was pneumothorax in 27 cases; there were no cases of PNX requiring chest tube insertion. Intrapulmonary bleeding along the needle track was observed in 32 patients. Exploiting the advantage of MPR images, our novel technique of extra-pleuric coaxial system with a 18-G EPN allows the operator to multiple samplings of small (≤20 mm) target lesions in various locations with a thinner (22-G Chiba) needle, thus reducing the degree of pleural, parenchymal, or adjacent organs damage.
authors.affiliation: Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via Francesco De Sanctis, 1, 86100, Campobasso, Italy. dott.ssacapasso@gmail.com.
authors.forename: Raffaella
authors.identifier: http://orcid.org/0000-0002-6033-8463
authors.initials: R
authors.lastname: Capasso
authors.affiliation: Medical Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43100, Parma, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Nizzoli
authors.affiliation: Medical Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43100, Parma, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tiseo
authors.affiliation: Department of Neuroscience, University of Parma, Via Gramsci, 14, 43100, Parma, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pedrazzi
authors.affiliation: Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via Francesco De Sanctis, 1, 86100, Campobasso, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Brunese
authors.affiliation: Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Piazza Miraglia, 2, 80138, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rotondo
authors.affiliation: Department of Radiology, University of Parma, Parma Hospital, Via Gramsci, 14, 43100, Parma, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: De Filippo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects / Q000379:methods*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods*
keywords: CT guidance; Coaxial technique; Lung biopsy; MPR; Pneumothorax; Small nodule