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Published in: European Radiology 3/2013

01-03-2013 | Chest

Percutaneous transthoracic needle biopsy of small (≤1 cm) lung nodules under C-arm cone-beam CT virtual navigation guidance

Authors: Ji Yung Choo, Chang Min Park, Nyoung Keun Lee, Sang Min Lee, Hyun-Ju Lee, Jin Mo Goo

Published in: European Radiology | Issue 3/2013

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Abstract

Objectives

To describe our initial experience with percutaneous transthoracic needle biopsy (PCNB) of small (≤1 cm) lung nodules using a cone-beam computed tomography (CBCT) virtual navigation guidance system in 105 consecutive patients.

Methods

One hundred and five consecutive patients (55 male, 50 female; mean age, 62 years) with 107 small (≤1 cm) lung nodules (mean size, 0.85 cm ± 0.14) underwent PCNBs under CBCT virtual-navigation guidance system and constituted our study population. Procedural details—including radiation dose, sensitivity, specificity, diagnostic accuracy and complication rates of CBCT virtual navigation guided PCNBs—were described.

Results

The mean number of pleural passages with the coaxial needle, biopsies, CT acquisitions, total procedure time, coaxial introducer dwelling time, and estimated radiation exposure during PCNBs were 1.03 ± 0.21, 3.1 ± 0.7, 3.4 ± 1.3, 10.5 min ± 3.2 and 7.2 min ± 2.5, and 5.72 mSv ± 4.19, respectively. Sixty nodules (56.1 %) were diagnosed as malignant, 38 (35.5 %) as benign and nine (8.4 %) as indeterminate. The sensitivity, specificity, and diagnostic accuracy of CBCT virtual-navigation-guided PCNB for small (≤1 cm) nodules were 96.7 % (58/60), 100 % (38/38) and 98.0 % (96/98), respectively. Complications occurred in 13 (12.1 %) cases; pneumothorax in seven (6.5 %) and haemoptysis in six (5.6 %).

Conclusion

CBCT virtual-navigation-guided PCNB is a highly accurate and safe diagnostic method for small (≤1 cm) nodules.

Key Points

CBCT virtual-navigation guidance offers new biopsy options for lung nodules
CBCT virtual-navigation-guided PCNB is highly accurate for small (≤1 cm) nodules
CBCT virtual-navigation-guided PCNB for small (≤1 cm) nodules is safe
Procedure time and radiation exposure of CBCT virtual-navigation-guided PCNB is reasonable
Literature
1.
go back to reference Henschke CI, McCauley DI, Yankelevitz DF et al (1999) Early lung cancer action project: Overall design and findings from baseline screening. Lancet 354:99–105PubMedCrossRef Henschke CI, McCauley DI, Yankelevitz DF et al (1999) Early lung cancer action project: Overall design and findings from baseline screening. Lancet 354:99–105PubMedCrossRef
2.
go back to reference Heck SL, Blom P, Berstad A (2006) Accuracy and complications in computed tomography fluoroscopy-guided needle biopsies of lung masses. Eur Radiol 16:1387–1392PubMedCrossRef Heck SL, Blom P, Berstad A (2006) Accuracy and complications in computed tomography fluoroscopy-guided needle biopsies of lung masses. Eur Radiol 16:1387–1392PubMedCrossRef
3.
go back to reference Jin KN, Park CM, Goo JM et al (2010) Initial experience of percutaneous transthoracic needle biopsy of lung nodules using C-arm cone-beam CT systems. Eur Radiol 20:2108–2115PubMedCrossRef Jin KN, Park CM, Goo JM et al (2010) Initial experience of percutaneous transthoracic needle biopsy of lung nodules using C-arm cone-beam CT systems. Eur Radiol 20:2108–2115PubMedCrossRef
4.
go back to reference Ohno Y, Hatabu H, Takenaka D et al (2003) CT-guided transthoracic needle aspiration biopsy of small (< or =20 mm) solitary pulmonary nodules. AJR Am J Roentgenol 180:1665–1669PubMed Ohno Y, Hatabu H, Takenaka D et al (2003) CT-guided transthoracic needle aspiration biopsy of small (< or =20 mm) solitary pulmonary nodules. AJR Am J Roentgenol 180:1665–1669PubMed
5.
go back to reference Katada K, Kato R, Anno H et al (1996) Guidance with real-time CT fluoroscopy: Early clinical experience. Radiology 200:851–856PubMed Katada K, Kato R, Anno H et al (1996) Guidance with real-time CT fluoroscopy: Early clinical experience. Radiology 200:851–856PubMed
6.
go back to reference Kato R, Katada K, Anno H, Suzuki S, Ida Y, Koga S (1996) Radiation dosimetry at CT fluoroscopy: Physician’s hand dose and development of needle holders. Radiology 201:576–578PubMed Kato R, Katada K, Anno H, Suzuki S, Ida Y, Koga S (1996) Radiation dosimetry at CT fluoroscopy: Physician’s hand dose and development of needle holders. Radiology 201:576–578PubMed
7.
go back to reference Kim GR, Hur J, Lee SM et al (2011) CT fluoroscopy-guided lung biopsy versus conventional CT-guided lung biopsy: A prospective controlled study to assess radiation doses and diagnostic performance. EEur Radiol 21:232–239CrossRef Kim GR, Hur J, Lee SM et al (2011) CT fluoroscopy-guided lung biopsy versus conventional CT-guided lung biopsy: A prospective controlled study to assess radiation doses and diagnostic performance. EEur Radiol 21:232–239CrossRef
8.
go back to reference Wallace MJ, Kuo MD, Glaiberman C, Binkert CA, Orth RC, Soulez G (2009) Three-dimensional C-arm cone-beam CT: applications in the interventional suite. J Vasc Interv Radiol 20:S523–S537PubMedCrossRef Wallace MJ, Kuo MD, Glaiberman C, Binkert CA, Orth RC, Soulez G (2009) Three-dimensional C-arm cone-beam CT: applications in the interventional suite. J Vasc Interv Radiol 20:S523–S537PubMedCrossRef
9.
go back to reference Kalender WA, Kyriakou Y (2007) Flat-detector computed tomography (FD-CT). Eur Radiol 17:2767–2779PubMedCrossRef Kalender WA, Kyriakou Y (2007) Flat-detector computed tomography (FD-CT). Eur Radiol 17:2767–2779PubMedCrossRef
10.
go back to reference Gupta R, Cheung AC, Bartling SH et al (2008) Flat-panel volume CT: Fundamental principles, technology, and applications. Radiographics 28:2009–2022PubMedCrossRef Gupta R, Cheung AC, Bartling SH et al (2008) Flat-panel volume CT: Fundamental principles, technology, and applications. Radiographics 28:2009–2022PubMedCrossRef
11.
go back to reference Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J (2008) Fleischner society: Glossary of terms for thoracic imaging. Radiology 246:697–722PubMedCrossRef Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J (2008) Fleischner society: Glossary of terms for thoracic imaging. Radiology 246:697–722PubMedCrossRef
12.
go back to reference Richter C, Pawelke J, Karsch L, Woithe J (2009) Energy dependence of EBT-1 radiochromic film response for photon (10 kvp-15 MVp) and electron beams (6–18 MeV) readout by a flatbed scanner. Med Phys 36:5506–5514PubMedCrossRef Richter C, Pawelke J, Karsch L, Woithe J (2009) Energy dependence of EBT-1 radiochromic film response for photon (10 kvp-15 MVp) and electron beams (6–18 MeV) readout by a flatbed scanner. Med Phys 36:5506–5514PubMedCrossRef
13.
go back to reference International Commission on Radiological Protection(2007) The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 37:1–332 International Commission on Radiological Protection(2007) The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 37:1–332
14.
go back to reference Hwang HS, Chung MJ, Lee JW, Shin SW, Lee KS (2010) C-arm cone-beam CT-guided percutaneous transthoracic lung biopsy: Usefulness in evaluation of small pulmonary nodules. AJR Am J Roentgenol 195:W400–W407PubMedCrossRef Hwang HS, Chung MJ, Lee JW, Shin SW, Lee KS (2010) C-arm cone-beam CT-guided percutaneous transthoracic lung biopsy: Usefulness in evaluation of small pulmonary nodules. AJR Am J Roentgenol 195:W400–W407PubMedCrossRef
15.
go back to reference Larscheid RC, Thorpe PE, Scott WJ (1998) Percutaneous transthoracic needle aspiration biopsy: A comprehensive review of its current role in the diagnosis and treatment of lung tumors. Chest 114:704–709PubMedCrossRef Larscheid RC, Thorpe PE, Scott WJ (1998) Percutaneous transthoracic needle aspiration biopsy: A comprehensive review of its current role in the diagnosis and treatment of lung tumors. Chest 114:704–709PubMedCrossRef
16.
go back to reference Manhire A, Charig M, Clelland C et al (2003) Guidelines for radiologicalally guided lung biopsy. Thorax 58:920–936PubMedCrossRef Manhire A, Charig M, Clelland C et al (2003) Guidelines for radiologicalally guided lung biopsy. Thorax 58:920–936PubMedCrossRef
17.
go back to reference Westcott JL, Rao N, Colley DP (1997) Transthoracic needle biopsy of small pulmonary nodules. Radiology 202:97–103PubMed Westcott JL, Rao N, Colley DP (1997) Transthoracic needle biopsy of small pulmonary nodules. Radiology 202:97–103PubMed
18.
go back to reference Tsukada H, Satou T, Iwashima A, Souma T (2000) Diagnostic accuracy of CT-guided automated needle biopsy of lung nodules. AJR Am J Roentgenol 175:239–243PubMed Tsukada H, Satou T, Iwashima A, Souma T (2000) Diagnostic accuracy of CT-guided automated needle biopsy of lung nodules. AJR Am J Roentgenol 175:239–243PubMed
19.
go back to reference Yeow KM, Tsay PK, Cheung YC, Lui KW, Pan KT, Chou AS (2003) Factors affecting diagnostic accuracy of CT-guided coaxial cutting needle lung biopsy: Retrospective analysis of 631 procedures. J Vasc Interv Radiol 14:581–588PubMedCrossRef Yeow KM, Tsay PK, Cheung YC, Lui KW, Pan KT, Chou AS (2003) Factors affecting diagnostic accuracy of CT-guided coaxial cutting needle lung biopsy: Retrospective analysis of 631 procedures. J Vasc Interv Radiol 14:581–588PubMedCrossRef
20.
go back to reference Yamagami T, Iida S, Kato T, Tanaka O, Nishimura T (2003) Combining fine-needle aspiration and core biopsy under CT fluoroscopy guidance: A better way to treat patients with lung nodules? AJR Am J Roentgenol 180:811–815PubMed Yamagami T, Iida S, Kato T, Tanaka O, Nishimura T (2003) Combining fine-needle aspiration and core biopsy under CT fluoroscopy guidance: A better way to treat patients with lung nodules? AJR Am J Roentgenol 180:811–815PubMed
21.
go back to reference Wallace MJ, Krishnamurthy S, Broemeling LD et al (2002) CT-guided percutaneous fine-needle aspiration biopsy of small (< or =1-cm) pulmonary lesions. Radiology 225:823–828PubMedCrossRef Wallace MJ, Krishnamurthy S, Broemeling LD et al (2002) CT-guided percutaneous fine-needle aspiration biopsy of small (< or =1-cm) pulmonary lesions. Radiology 225:823–828PubMedCrossRef
22.
go back to reference Hiraki T, Mimura H, Gobara H et al (2009) CT fluoroscopy-guided biopsy of 1,000 pulmonary lesions performed with 20-gauge coaxial cutting needles: Diagnostic yield and risk factors for diagnostic failure. Chest 136:1612–1617PubMedCrossRef Hiraki T, Mimura H, Gobara H et al (2009) CT fluoroscopy-guided biopsy of 1,000 pulmonary lesions performed with 20-gauge coaxial cutting needles: Diagnostic yield and risk factors for diagnostic failure. Chest 136:1612–1617PubMedCrossRef
23.
go back to reference Braak SJ, Herder GJ, van Heesewijk JP, van Strijen MJ (2011) Pulmonary masses: Initial results of cone-beam CT guidance with needle planning software for percutaneous lung biopsy. Cardiovasc Intervent Radiol. doi:10.1007/s00270-011-0302-z PubMed Braak SJ, Herder GJ, van Heesewijk JP, van Strijen MJ (2011) Pulmonary masses: Initial results of cone-beam CT guidance with needle planning software for percutaneous lung biopsy. Cardiovasc Intervent Radiol. doi:10.​1007/​s00270-011-0302-z PubMed
24.
go back to reference Carlson SK, Felmlee JP, Bender CE et al (2005) CT fluoroscopy-guided biopsy of the lung or upper abdomen with a breath-hold monitoring and feedback system: A prospective randomized controlled clinical trial. Radiology 237:701–708PubMedCrossRef Carlson SK, Felmlee JP, Bender CE et al (2005) CT fluoroscopy-guided biopsy of the lung or upper abdomen with a breath-hold monitoring and feedback system: A prospective randomized controlled clinical trial. Radiology 237:701–708PubMedCrossRef
25.
go back to reference Schaefer PJ, Schaefer FK, Heller M, Jahnke T (2007) CT fluoroscopy guided biopsy of small pulmonary and upper abdominal lesions: Efficacy with a modified breathing technique. J Vasc Interv Radiol 18:1241–1248PubMedCrossRef Schaefer PJ, Schaefer FK, Heller M, Jahnke T (2007) CT fluoroscopy guided biopsy of small pulmonary and upper abdominal lesions: Efficacy with a modified breathing technique. J Vasc Interv Radiol 18:1241–1248PubMedCrossRef
26.
go back to reference Priola AM, Priola SM, Cataldi A et al (2010) Diagnostic accuracy and complication rate of CT-guided fine needle aspiration biopsy of lung lesions: A study based on the experience of the cytopathologist. Acta Radiol 51:527–533PubMedCrossRef Priola AM, Priola SM, Cataldi A et al (2010) Diagnostic accuracy and complication rate of CT-guided fine needle aspiration biopsy of lung lesions: A study based on the experience of the cytopathologist. Acta Radiol 51:527–533PubMedCrossRef
27.
go back to reference Ko JP, Shepard JO, Drucker EA et al (2001) Factors influencing pneumothorax rate at lung biopsy: Are dwell time and angle of pleural puncture contributing factors? Radiology 218:491–496PubMed Ko JP, Shepard JO, Drucker EA et al (2001) Factors influencing pneumothorax rate at lung biopsy: Are dwell time and angle of pleural puncture contributing factors? Radiology 218:491–496PubMed
28.
go back to reference Lee CH, Goo JM, Ye HJ et al (2008) Radiation dose modulation techniques in the multidetector CT era: From basics to practice. Radiographics 28:1451–1459PubMedCrossRef Lee CH, Goo JM, Ye HJ et al (2008) Radiation dose modulation techniques in the multidetector CT era: From basics to practice. Radiographics 28:1451–1459PubMedCrossRef
Metadata
Title
Percutaneous transthoracic needle biopsy of small (≤1 cm) lung nodules under C-arm cone-beam CT virtual navigation guidance
Authors
Ji Yung Choo
Chang Min Park
Nyoung Keun Lee
Sang Min Lee
Hyun-Ju Lee
Jin Mo Goo
Publication date
01-03-2013
Publisher
Springer-Verlag
Published in
European Radiology / Issue 3/2013
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-012-2644-6

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