A Systematic Review and Meta-Analysis of C-Arm Cone-Beam CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Nodules

Abstract

SummaryBackgroundA systematic review and meta-analysis of all available publications was performed to evaluate the diagnostic accuracy of percutaneous transthoracic needle biopsy (PTNB) using a C-Arm Cone-Beam CT (CBCT) system in patients with lung nodules.Material/MethodsThedatabases of PUBMED, OVID, EBSCO, EMBASE, and China National Knowledge Infrastructure (CNKI) were systematically searched for relevant original articles on the diagnostic accuracy of CBCT-guided PTNB for the diagnosis of nodules in the lungs. Diagnostic indices including sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and diagnostic score (DS) were calculated. Moreover,summary receiver operating characteristic curves (SROC) were constructed with Stata (version 13.0), Rev Man (version 5.3), and Meta-disc (version 1.4) software. Other clinical indices such as incidence of complications were also recorded.ResultsEight studies met the inclusion and exclusion criteria for the meta-analysis. The pooled sensitivity, specificity, PLR, NLR, DOR, DS, and SROC with 95% confidence intervals were 0.96 (0.93–0.98), 1.00 (0.91–1.00), 711.15 (9.48–53325.89), 0.04 (0.02–0.07), 16585.29 (284.88–9.7e+05), 9.72 (5.65–13.78), and 0.99 (0.97–0.99), respectively. The incidence of pneumothorax and hemorrhage was 10–29.27% and 1.22–47.25%, respectively.ConclusionsCBCT-guided PTNB has an acceptable rate of complications and is associated with a reasonable radiation exposure. Moreover, it is a highly accurate and safe technique for the diagnosis of lung nodules and can be recommended to be used in routine clinical practice.

CT-Guided Percutaneous Transthoracic Needle Biopsy Using the Additional Laser Guidance System by a Pulmonologist with 2 Years of Experience in CT-Guided Percutaneous Transthoracic Needle Biopsy

“…CBCT is very expensive and requires a large physical space for the equipment. Therefore, considering the diagnostic yield and patient safety of conventional CT reported in recent studies, which are comparable with those of CBCT, it is preferable to improve existing conventional CT-guided PTNB than to purchase a CBCT system 1 2 3 4 11 12 . We developed the additional laser guidance system to improve the efficacy and safety of conventional CT-guided PTNB.…”

A Formula for Calculating Deviation of Computed Tomography-Guided Puncture Point

“…CT-guided percutaneous biopsy and interventional treatment have numerous advantages, such as high accuracy of position, little damage of tissue, little pain of patients, and wide use in clinical practice. [ 1 3 6 ] There is no need to rotate the gantry angle (θ = 0°) for most of the patients, when they undergo needle biopsy guided by CT. But when it needs to turn angles, the author found that it was hard to confirm the right puncture point according to Equation 2.…”

The Society for Translational Medicine: indications and methods of percutaneous transthoracic needle biopsy for diagnosis of lung cancer

“…Massive hemothorax is often caused by the injury of intercostal arteries or the pulmonary artery, for which an open or video-assisted thoracoscopic surgery may be required to achieve hemostasis; (III) Air embolism (43,55,64,65): air embolism is an extremely rare complication but may cause cerebral or spinal cord infarction, myocardial infarction, arrhythmia, heart failure, or even death. Once air embolism occurs, the patient should be immediately placed left lateral decubitus or Trendelenburg's position to prevent residual air in left atrium to pass into the systemic circulation; concurrently, 100% oxygen must be administered to the patient to promote the absorption of the air embolus.…”

“…Once air embolism occurs, the patient should be immediately placed left lateral decubitus or Trendelenburg's position to prevent residual air in left atrium to pass into the systemic circulation; concurrently, 100% oxygen must be administered to the patient to promote the absorption of the air embolus. The patient can also be transferred for hyperbaric oxygen treatment; (IV) Needle-tract seeding of tumor cells (17,64,65):…”