Top

European Radiology

Published in:

01-12-2015 | Chest

C-Arm Cone-Beam CT Virtual Navigation-Guided Percutaneous Mediastinal Mass Biopsy: Diagnostic Accuracy and Complications

Authors: Hyungjin Kim, Chang Min Park, Sang Min Lee, Jin Mo Goo

Published in: European Radiology | Issue 12/2015

Abstract

Objectives

To assess the usefulness of C-arm cone-beam computed tomography (CBCT) virtual navigation-guided percutaneous mediastinal mass biopsy in terms of diagnostic accuracy and complication rates.

Methods

Seventy-eight CBCT virtual navigation-guided percutaneous mediastinal mass biopsies were performed in 75 patients (M:F, 38:37; mean age, 48.55 ± 18.76 years). The procedural details, diagnostic sensitivity, specificity, accuracy and complication rate were investigated.

Results

Mean lesion size was 6.80 ± 3.08 cm, skin-to-target distance was 3.67 ± 1.80 cm, core needle biopsy rate was 96.2 % (75/78), needle indwelling time was 9.29 ± 4.34 min, total procedure time was 13.26 ± 5.29 min, number of biopsy specimens obtained was 3.13 ± 1.02, number of CBCTs performed was 3.03 ± 0.68, rate of lesion border discrimination from abutting mediastinal structures on CBCT was 26.9 % (21/78), technical success rate was 100 % (78/78), estimated effective dose was 5.33 ± 4.99 mSv, and the dose area product was 12,723.68 ± 10,665.74 mGy⋅cm². Among the 78 biopsies, 69 were malignant, 7 were benign and 2 were indeterminate. Diagnostic sensitivity, specificity and accuracy for the diagnosis of malignancies were 97.1 % (67/69), 100 % (7/7) and 97.4 % (74/76), respectively, with a complication rate of 3.85 % (3/78), all of which were small pneumothoraces.

Conclusions

CBCT virtual navigation-guided biopsy is a highly accurate and safe procedure for the evaluation of mediastinal lesions.

Key Points

• CBCT virtual navigation-guided percutaneous mediastinal biopsy is highly accurate

• CBCT virtual navigation-guided percutaneous mediastinal biopsy is a safe procedure

• Mediastinal vascular injury can be avoided under CBCT virtual navigation guidance

Gupta S, Seaberg K, Wallace MJ et al (2005) Imaging-guided percutaneous biopsy of mediastinal lesions: different approaches and anatomic considerations. Radiographics 25:763–786CrossRefPubMed

de Jiao C, Li TF, Han XW et al (2014) Clinical applications of the C-arm cone-beam CT-based 3D needle guidance system in performing percutaneous transthoracic needle biopsy of pulmonary lesions. Diagn Interv Radiol 20:470–474PubMedCentralCrossRef

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 237:701–708CrossRefPubMed

Choi JW, Park CM, Goo JM et al (2012) C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of small (≤20 mm) lung nodules: diagnostic accuracy and complications in 161 patients. AJR Am J Roentgenol 199:W322–W330CrossRefPubMed

Yankelevitz DF, Vazquez M, Henschke CI (2000) Special techniques in transthoracic needle biopsy of pulmonary nodules. Radiol Clin N Am 38:267–279CrossRefPubMed

Nawfel RD, Judy PF, Silverman SG, Hooton S, Tuncali K, Adams DF (2000) Patient and personnel exposure during CT fluoroscopy-guided interventional procedures. Radiology 216:180–184CrossRefPubMed

Wallace MJ, Kuo MD, Glaiberman C et al (2009) Three-dimensional C-arm cone-beam CT: applications in the interventional suite. J Vasc Interv Radiol 20:S523–S537CrossRefPubMed

Choo JY, Park CM, Lee NK, Lee SM, Lee HJ, Goo JM (2013) Percutaneous transthoracic needle biopsy of small (≤1 cm) lung nodules under C-arm cone-beam CT virtual navigation guidance. Eur Radiol 23:712–719CrossRefPubMed

Braak SJ, Herder GJ, van Heesewijk JP, van Strijen MJ (2012) Pulmonary masses: initial results of cone-beam CT guidance with needle planning software for percutaneous lung biopsy. Cardiovasc Intervent Radiol 35:1414–1421CrossRefPubMed

10.

Cheung JY, Kim Y, Shim SS, Lim SM (2011) Combined fluoroscopy- and CT-guided transthoracic needle biopsy using a C-arm cone-beam CT system: comparison with fluoroscopy-guided biopsy. Korean J Radiol 12:89–96PubMedCentralCrossRefPubMed

11.

Choi MJ, Kim Y, Hong YS, Shim SS, Lim SM, Lee JK (2012) Transthoracic needle biopsy using a C-arm cone-beam CT system: diagnostic accuracy and safety. Br J Radiol 85:e182–e187PubMedCentralCrossRefPubMed

12.

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–W407CrossRefPubMed

13.

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 20:2108–2115CrossRefPubMed

14.

Lee SM, Park CM, Lee KH, Bahn YE, Kim JI, Goo JM (2014) C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules: clinical experience in 1108 patients. Radiology 271:291–300CrossRefPubMed

15.

Lee WJ, Chong S, Seo JS, Shim HJ (2012) Transthoracic fine-needle aspiration biopsy of the lungs using a C-arm cone-beam CT system: diagnostic accuracy and post-procedural complications. Br J Radiol 85:e217–e222PubMedCentralCrossRefPubMed

16.

Kim JI, Park CM, Lee SM, Goo JM (2015) Rapid needle-out patient-rollover approach after cone beam CT-guided lung biopsy: effect on pneumothorax rate in 1,191 consecutive patients. Eur Radiol. doi:10.1007/s00330-015-3601-y

17.

Carrafiello G, Fontana F, Mangini M et al (2012) Initial experience with percutaneous biopsies of bone lesions using XperGuide cone-beam CT (CBCT): technical note. Radiol Med 117:1386–1397CrossRefPubMed

18.

Leschka SC, Babic D, El Shikh S, Wossmann C, Schumacher M, Taschner CA (2012) C-arm cone beam computed tomography needle path overlay for image-guided procedures of the spine and pelvis. Neuroradiology 54:215–223CrossRefPubMed

19.

Whitten CR, Khan S, Munneke GJ, Grubnic S (2007) A diagnostic approach to mediastinal abnormalities. Radiographics 27:657–671CrossRefPubMed

20.

Riedel RF, Burfeind WR Jr (2006) Thymoma: benign appearance, malignant potential. Oncologist 11:887–894CrossRefPubMed

21.

Suster S, Moran CA (2006) Thymoma classification: current status and future trends. Am J Clin Pathol 125:542–554CrossRefPubMed

22.

Gupta S, Wallace MJ, Morello FA Jr, Ahrar K, Hicks ME (2002) CT-guided percutaneous needle biopsy of intrathoracic lesions by using the transsternal approach: experience in 37 patients. Radiology 222:57–62CrossRefPubMed

23.

Hagberg H, Ahlstrom HK, Magnusson A, Sundstrom C, Astrom GK (2000) Value of transsternal core biopsy in patients with a newly diagnosed mediastinal mass. Acta Oncol 39:195–198CrossRefPubMed

24.

Kulkarni S, Kulkarni A, Roy D, Thakur MH (2008) Percutaneous computed tomography-guided core biopsy for the diagnosis of mediastinal masses. Ann Thorac Med 3:13–17PubMedCentralCrossRefPubMed

25.

Lin ZY, Li YG (2009) Artificial pneumothorax with position adjustment for computed tomography-guided percutaneous core biopsy of mediastinum lesions. Ann Thorac Surg 87:920–924CrossRefPubMed

26.

Priola AM, Priola SM, Cataldi A et al (2008) CT-guided percutaneous transthoracic biopsy in the diagnosis of mediastinal masses: evaluation of 73 procedures. Radiol Med 113:3–15CrossRefPubMed

27.

Zwischenberger JB, Savage C, Alpard SK, Anderson CM, Marroquin S, Goodacre BW (2002) Mediastinal transthoracic needle and core lymph node biopsy: should it replace mediastinoscopy? Chest 121:1165–1170CrossRefPubMed

28.

Busser WM, Braak SJ, Futterer JJ et al (2013) Cone beam CT guidance provides superior accuracy for complex needle paths compared with CT guidance. Br J Radiol 86:20130310PubMedCentralCrossRefPubMed

29.

Greif J, Staroselsky AN, Gernjac M et al (1999) Percutaneous core needle biopsy in the diagnosis of mediastinal tumors. Lung Cancer 25:169–173CrossRefPubMed

30.

Sklair-Levy M, Polliack A, Shaham D et al (2000) CT-guided core-needle biopsy in the diagnosis of mediastinal lymphoma. Eur Radiol 10:714–718CrossRefPubMed

31.

Zinzani PL, Corneli G, Cancellieri A et al (1999) Core needle biopsy is effective in the initial diagnosis of mediastinal lymphoma. Haematologica 84:600–603PubMed

32.

Schegerer AA, Lechel U, Ritter M, Weisser G, Fink C, Brix G (2014) Dose and image quality of cone-beam computed tomography as compared with conventional multislice computed tomography in abdominal imaging. Investig Radiol 49:675–684CrossRef

33.

Lee CH, Goo JM, Ye HJ et al (2008) Radiation dose modulation techniques in the multidetector CT era: from basics to practice. Radiographics 28:1451–1459CrossRefPubMed

Title: C-Arm Cone-Beam CT Virtual Navigation-Guided Percutaneous Mediastinal Mass Biopsy: Diagnostic Accuracy and Complications
Authors: Hyungjin Kim
Chang Min Park
Sang Min Lee
Jin Mo Goo
Publication date: 01-12-2015
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 12/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-015-3762-8

At a glance: The STEP trials

Springer Medicine

C-Arm Cone-Beam CT Virtual Navigation-Guided Percutaneous Mediastinal Mass Biopsy: Diagnostic Accuracy and Complications

Abstract

Objectives

Methods

Results

Conclusions

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 12/2015

An anatomical study of the indirect tendon of the rectus femoris using ultrasonography

Whole-body MRI in adult inflammatory myopathies: Do we need imaging of the trunk?

Diagnostic performance of the automated breast volume scanner: a systematic review of inter-rater reliability/agreement and meta-analysis of diagnostic accuracy for differentiating benign and malignant breast lesions

Free DICOM de-identification tools in clinical research: functioning and safety of patient privacy

The proliferation of multidisciplinary team meetings (MDTMs): how can radiology departments continue to support them all?

Lung cancer risk and cancer-specific mortality in subjects undergoing routine imaging test when stratified with and without identified lung nodule on imaging study