Published in:
Open Access 01-11-2012 | Interventional
3D cone-beam CT guidance, a novel technique in renal biopsy—results in 41 patients with suspected renal masses
Published in: European Radiology | Issue 11/2012
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Objective
To determine whether 3D cone-beam computed tomography (CBCT) guidance allows safe and accurate biopsy of suspected small renal masses (SRM), especially in hard-to-reach anatomical locations.
Materials and methods
CBCT guidance was used to perform 41 stereotactic biopsy procedures of lesions that were inaccessible for ultrasound guidance or CT guidance. In CBCT guidance, a 3D-volume data set is acquired by rotating a C-arm flat-panel detector angiosystem around the patient. In the data set, a needle trajectory is determined and, after co-registration, a fusion image is created from fluoroscopy and a slice from the data set, enabling the needle to be positioned in real time.
Results
Of the 41 lesions, 22 were malignant, 17 were benign, and 2 were nondiagnostic. The two nondiagnostic lesions proved to be renal cell carcinoma. There was no growth during follow-up imaging of the benign lesions (mean 29 months). This resulted in a sensitivity, specificity, PPV, NPV, and accuracy of 91.7, 100, 100, 89.5, and 95.1%, respectively. Mean dose-area product value was 44.0 Gy·cm2 (range 16.5–126.5). There was one minor bleeding complication.
Conclusion
With CBCT guidance, safe and accurate biopsy of a suspected SRM is feasible, especially in hard-to-reach locations of the kidney.
Key Points
• Cone-beam computed tomography has potential advantages over conventional CT for interventional procedures.
• CBCT guidance incorporates 3D CBCT data, fluoroscopy, and guidance software.
• In hard-to-reach renal masses, CBCT guidance offers an alternative biopsy method.
• CBCT guidance offers good outcome and safety and has potential clinical significance.